Sometimes, quite serious pathologies hide behind habitual and insignificant symptoms. For example, the secretion of liquid secretion from the nasal passages does not always occur with a runny nose. This disorder may indicate nasal liquorrhea. Signs, diagnostic methods and treatment options for this disease will be discussed in detail in today's article.
Anatomical reference
Liquor is cerebrospinal fluid, the main function of which is to ensure the full functioning of the brain. In a healthy person, this transparent and watery secret fills his ventricles and cisterns, the central channel of the spinal cord. Liquor plays a cushioning role, maintaining a constant intracranial pressure and electrolyte balance.
Through cerebrospinal fluid, the breakdown products of brain metabolism are eliminated. It constantly circulates in a confined space: from the ventricles into the subarachnoid space, and from there into the venous sinuses. Updating occurs approximately 4 times a day. In its composition, the watery secret resembles a blood plasma.
The mechanism of the development of the disease
Nasal liquorrhea develops due to a violation of the integrity of the skull. The nasal cavity is separated from the intracranial sinuses. At its expiration, a transparent secret first fills one of the paranasal sinuses. As a rule, we are talking about a wedge-shaped, frontal or trellised labyrinth. Then, from the corresponding sinus, cerebrospinal fluid flows directly into the nasal cavity. The fluid can flow out through the nostrils to the outside or enter the esophagus through the nasopharynx.
Main reasons
As noted above, cerebrospinal fluid can only be in the cavities of the brain or in the so-called subshell space. Therefore, in a healthy person, this substance cannot penetrate outside. For this, a prerequisite is damage to the walls that limit the circulation of cerebrospinal fluid. Most often, the cause of nasal liquorrhea is traumatic brain injury. They happen against a background of car accidents, falls from a height or injuries. In these situations, the following structures are damaged:
- trellis maze;
- anterior cranial fossa;
- frontal / sphenoid sinus;
- pyramid of the temporal bone.
There are cases of violation of the integrity of the bone walls during surgical interventions in ENT practice and neurosurgery. We are talking about operations to remove polyps or purulent complications of sinusitis.
Among other causes of the disease, doctors note:
- tumor processes in the body;
- hernias of the meninges;
- prolonged intracranial hypertension.
Cases of spontaneous nasal liquorrhea should be considered separately. This is a very rare disease that can be triggered by congenital disorders in the structure of the lattice plate of the skull and the part of the hard shell of the brain bordering on it. In this case, the outpouring of the secret occurs periodically and stops on its own. Usually the symptoms of the disorder appear after physical activity, especially after lifting weights. The occurrence of the disease, some doctors associate with hereditary brain pathologies due to venous congestion and increased intracranial pressure.
Classification of liquorrhea
Any pathology has its own varieties. Nasal liquorrhea can occur in two forms:
- Primary occurs immediately after damage or injury.
- The secondary appears after some period of time necessary for the formation of the fistula.
Depending on the external manifestations, the disease may have a clear or latent course. The latter option is quite difficult to diagnose in a timely manner. In this case, the liquid does not stand out, but is constantly swallowed by the patient.
Clinical picture
Symptoms of nasal liquorrhea can be both external and internal. What are the signs that the patient first draws attention to?
First, a clear fluid periodically flows from the nose. Most patients perceive it as the primary manifestations of the common cold. However, liquorrhea differs from the usual secretion in a more oily structure. In addition, the level of outflow is continuous, and stops only during a change in body position.
Another symptom of the disease is a headache. Its appearance is due to a decrease in the volume of cerebrospinal fluid and a decrease in pressure. Some patients have a cough during sleep, a feeling of suffocation. These phenomena are due to the fact that the secret does not pour out, but penetrates directly into the respiratory tract.
Diagnostic Methods
Diagnosis of nasal liquorrhea is usually carried out in several stages. When a patient enters a medical institution with a traumatic brain injury, he is immediately sent to an MRI or CT scan. Such an examination allows you to quickly detect defects in the meninges, provoked by a violation of the integrity of the bones of the skull.
Otherwise, when the injury is insignificant or the patient has not sought medical help for a long time, the diagnosis of pathology is reduced to an external examination, a history of the study. The doctor draws attention to events that preceded the symptoms (injuries, operations, car accidents or other injuries).
Sometimes only clinical manifestations to confirm the diagnosis are not enough. If the disease has a non-traumatic origin, it must be differentiated with serous secretions. For this purpose, an analysis of the secret is carried out with the determination of indicators of protein and sugar in it. For nasal liquorrhea, a glucose content of 10-50% is characteristic, and a protein is not higher than 0.33 g / l. With a common cold, the values are completely opposite: a lot of protein and almost no sugar.
Conservative treatment
Therapy for this disease is aimed not only at eliminating it, but also at eliminating the root cause. Therefore, doctors use both conservative and surgical methods of exposure. Consider what each of them is in more detail.
Conservative treatment of nasal liquorrhea begins with providing the patient with bed rest. He is strictly forbidden to bend down, push, blow his nose, sneeze and even cough. This approach minimizes fluid leakage. To avoid the penetration of infection into the lining of the brain, the patient is prescribed antibiotics and NSAIDs. Diuretics may be required to reduce fluid pressure in the skull. In especially serious cases, a lumbar puncture is performed.
Surgical intervention
When conservative therapy is ineffective, surgery is recommended. Surgery for nasal liquorrhea is also indicated in case of serious head injuries, gunshot wounds.
During surgical procedures, the doctor performs suturing of the ruptures of the brain membrane. He has to restore the integrity of the cranial bones. Subsequent treatment involves taking antibacterial drugs to minimize the risk of inflammation.
If a fistula is detected, the surgeon initially thoroughly cleans the course. Then it is sutured and sealed with all available methods. These manipulations play an important role, since they minimize the risk of serious complications. It is about joining a secondary infection and the constant flow of cerebrospinal fluid.
With severe damage to the skull, cerebrospinal fluid outflow can be very intense, indicating a sharp drop in intracranial pressure. This disorder is always accompanied by severe headaches, and sometimes provokes loss of consciousness.
Possible complications
According to ICD-10, nasal liquorrhea has the code G96.0. The disease is encrypted under the general code G96. This group also includes other and equally dangerous CNS pathologies. Such a classification allows us to understand that it is impossible to neglect an ailment and its treatment.
Leaking cerebrospinal fluid dangerously high probability of complications. Among them, the following disorders are most often found:
- meningitis;
- pneumocephaly;
- gastritis.
If concomitant health problems occur, the prognosis for liquorrhea is poor. That is why you should not risk your own health and ignore the initial manifestations of the disease. It is better to immediately seek qualified medical help and undergo a course of therapy prescribed by a specialist.