CSF rhinorrhea from encephalocolele secondary to pseudotumor cerebri

Discussion:

This is a classic constellation of findings. A middle aged female with features of intracranial hypertension (pseudotumor cerebri) develops multiple areas of medial sphenoid (middle cranial fossa) scalloping. Eventually one results in a meningocoele or meningoencephalocoele and ruptures into the sphenoid sinus resulting in CSF rhinorrhea

In many instances the prior elevated intracranial pressures have not been symptomatic or recognized and symptoms become more acute following CSF leak repair (suggesting that the leak was a form of 'self treatment'). 

The patient went on to have endoscopic repair of the defect at which time CSF was noted to be under unusually high pressures. 

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