Cerebrospinal Fluid Rhinorrhea

Cerebrospinal fluid (CSF) surrounds the brain and spinal cord. This "brain fluid" cushions the brain, maintains pressure within the eye, and cleanses the central nervous system much like the lymphatic system serves the same function in the rest of the body. Any tear or hole in the membrane that allows the cerebrospinal fluid to leak can cause a drop in pressure around the brain and spinal cord. When the fluid leaks from the nose, this condition is called CSF rhinorrhea.

Causes, Symptoms and Complications of CSF Rhinorrhea

Cerebrospinal fluid rhinorrhea can result from several causes including congenital causes, head trauma, intracranial surgery, destructive lesions or granulomatous diseases.

Symptoms include:

  • Headache that worsens when you sit up and improves when you lie down
  • Metallic taste in the back of the throat
  • Watery discharge from the nose or ear
  • Light sensitivity
  • Nausea
  • Neck stiffness

Cerebrospinal fluid rhinorrhea can lead to serious infectious complications such as meningitis, hydrocephalus or pneumocephalus, or the presence of air or gas within the cranial cavity.

Treatment for Cerebrospinal Fluid Rhinorrhea

Many cases resolve after a few days. Observation in the hospital, head of bed elevation or complete bed rest for several days is usually recommended. Increased fluids and pain relievers are also helpful to control symptoms.

Because CSF rhinorrhea is potentially a serious condition, surgery is sometimes needed to repair this leak. Modern imaging and endoscopic techniques have improved the ability to diagnose, localize and treat CSF leaks. A trans-nasal endoscopic repair of a CSF leak is less invasive than traditional surgical approaches through the skull and has a high success rate when performed by experienced specialists with endoscopic expertise, including those at BWH. The prognosis for a full recovery is excellent.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have cerebrospinal fluid rhinorrhea and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with cerebrospinal fluid rhinorrhea. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Learn more about your hospital stay, patient-centered care and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

Otolaryngology-Head and Neck Surgery Appointments and Locations


Learn more about other disorders of the ear, nose and throat in our health library.

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