All of us have had a runny nose at some point from allergies or a cold. But when Laura Clancy’s nose started running from only one nostril, it turned out to be something much more serious.
“I just assumed it was the start of a cold,” says Clancy, 61.
But it wasn’t ordinary mucus leaking from her nose. It was cerebrospinal fluid.
This fluid acts as a cushion for the brain and spine and protects against some diseases, among other things. When it leaks, it can lead to big problems.
“You can get complications from leaking brain fluid through the nose,” says Bobby Tajudeen, MD, a sinus specialist at RUSH. “These can be bad infections, like meningitis or encephalitis. You can also get air tracking into the brain because now there's an open space to the nose.”
When Clancy’s runny nose persisted, she started looking up her symptoms online. She came across the term “cerebrospinal fluid leak,” often shortened to CSF leak. That led her to Tajudeen, who knew exactly what she was going through — and how to treat it.
When it’s more than a runny nose
The runny nose was strange for a few reasons. For one, it was Clancy’s only symptom. She was still able to go to work as an executive assistant for a major airline during the day, and she could still enjoy her hobbies of quilting and watercolor painting.
“I was doing other things like I normally did,” she says. “However, I went through a lot of tissues. I had to have tissues on me constantly because I just never knew when a runny nose was going to happen.”
But the runny nose only came out of one nostril. Over time, she also noticed that it would come on more often when she leaned over.
“I was at a restaurant, and after sitting and chatting for a while without issues, I decided to go use the restroom. As soon as I went in and leaned over, it started happening,” she says. “And then I sat back at the table, and it was fine. Just weird things like that.”
When it kept happening after a few weeks, she searched for “intermittent runny nose” and other terms related to her symptoms online. After reading articles and watching videos from physicians, she started to suspect that she had a CSF leak.
That’s when she decided to find a specialist.
The signs of a CSF leak
Clancy made an appointment with Tajudeen, who was fairly sure he was seeing symptoms of a CSF leak.
“She was reporting clear drainage just from the right side of her nose,” he says. “That's kind of unusual because, generally when people get allergies or get sick, it affects the body equally. Both sides of the nose would be clogged.”
Tajudeen notes that patients with CSF leaks often go misdiagnosed for a long time because the condition has symptoms in common with many other health issues. They may get antibiotics or treatment for allergies, and sometimes they even get sinus surgery.
But Tajudeen examined Clancy and found the problem. “She had something called an encephalocele,” he says. “It’s a small outpouching of brain that can herniate into the nose. That's a common reason to develop a CSF leak.”
Brain surgery through the nose
The treatment for CSF leaks has changed in the modern age. Surgeons used to open the skull and reconstruct the bottom of the brain to patch the defect.
But now, surgeons can fix the problem through the nose with endoscopes and less-invasive techniques. That’s how Tajudeen treated Clancy.
“It’s almost like doing brain surgery through the nose,” he says. “We identified where the area of herniated brain was and removed that brain tissue.”
That brain tissue was nonfunctional, so it wouldn’t change Clancy’s thinking or brain function when removed.
After that, Tajudeen patched the hole to seal it, preventing more brain tissue from herniating and stopping the leakage.
A few weeks later, Clancy was feeling back to normal. She’s still able to drive, go to work and keep up with her hobbies. Tajudeen continues to monitor her brain fluid pressures with a team at RUSH to make sure there’s not a risk of another leak.
“I felt pretty good after treatment,” Clancy says. “Everything is normal now. Overall, I’m fine.”
She also has some advice if you have unusual symptoms like she did.
“If you have a runny nose all the time, and it’s only coming out of one nostril, definitely call your doctor,” she says. “And if you don’t have a leak but have headaches and vision problems, then that’s another reason to make a phone call and find out what’s causing that.”
Tajudeen recommends taking these symptoms seriously and visiting a specialist if you see them.
“If you have sinus infections or leak fluid from just one side of your nose, get that checked out,” he says. “Make sure you don't have, for example, a tumor blocking just one side or a brain fluid leak. You may have something simple like a deviated septum, and if that's what your physician identifies, great. But occasionally you may find other concerning conditions.”
If you need evaluation or treatment for a condition like CSF leak, call RUSH at (888) 352-7874. You can visit our Otorhinolaryngology, Head and Neck Surgery (ENT) Services page to learn more.
