Coronal computerized tomography and cerebrospinal fluid rhinorrhea

Accurate diagnosis of cerebrospinal fluid rhinorrhea (CSFR) is a challenge for physicians caring for patients with traumatic brain injury. Failure to recognize this condition may result in significant medical complications and prolong hospitalization. Two male patients who developed CSFR within 2 months of severe head injury are described. A clear nasal discharge was noted on examination approximately 30 and 35 days after head injury in both patients and a CSF fistula was suspected. High-resolution computerized tomography (CT) with coronal sections confirmed the diagnosis. Both patients underwent neurosurgical intervention to repair the fistulous tracts without recurrence. Sequelae of CSFR in one case included meningitis and pneumocephalus. Literature review shows water-soluble contrast CT cisternography (CTC) to be the gold standard for the diagnosis of CSFR. However, other diagnostic studies may include immunoelectrophoresis of rhinorrhea, use of isotope tracers, plain x-rays, tomography, and noncontrast high-resolution CT. More invasive studies like CTC are often recommended in the diagnosis of this condition, but are more costly, painful, and carry a small risk of infection. Our two case reports emphasize that high-resolution CT may be performed as a primary noninvasive diagnostic procedure before more invasive studies, and the results obtained may be sufficient for therapeutic planning.