Spontaneous Cerebrospinal Fluid Leakage From Nasal Septum Arachnoid Prolapse: Case Report

Spontaneous cerebrospinal fluid (CSF) leakage from the anterior skull base is frequently observed in overweight middle-aged women. CSF can be associated with idiopathic intracranial hypertension (IIH) without any triggering event.1The most frequent locations involved are the cribriform plate, lateral recess of the sphenoid sinus, ethmoidal roof, frontal sinus, and planum sphenoethmoidalis.2 However, the leakage associated with the nasal septum/lamina perpendicularis of the ethmoid is rare. In the literature we found only 1 case reported. It describes an arachnoid cyst that, from the anterior skull base, has developed along the perpendicular plate of the nasal septum.3A 36-year-old woman who was overweight (body mass index, 26.8) with diabetes mellitus type 2 was receiving treatment for a few years for IIH, which caused severe headache. A history of on-and-off watery leakage in the left nostril in the past 2 months was reported. The IIH was treated by acetazolamide (250 mg, twice per day). The office endoscopic endonasal evaluation did not detect any clear sign of leak. Collecting the fluid was feasible with the head bent downward and enforced by the Queckenstedt maneuver. The β2-transferrin positivity in the unilateral left nasal discharge confirmed the fluid to be CSF.