Cerobrospinal Fluid (CSF) Rhinorrhea Symptoms and Treatment

A rare but potentially serious complication most often due to nasal sinus surgery

Table of Contents
View All
Table of Contents

Cerebrospinal fluid (CSF) rhinorrhea is a rare condition in which cerebrospinal fluid, which usually cushions the brain and spinal cord, leaks from the nose. CSF rhinorrhea symptoms include headaches and runny nose. It can also lead to meningitis, an infection of the lining around the brain tissue (meninges).

This condition can happen when an abnormal tear is inadvertently created between the subarachnoid space of the brain and the nasal sinus cavities—for example, during surgery or trauma. Treatment includes preventing meningitis and possibly repairing a meningeal tear or a skull fracture.

This article reviews the symptoms, causes, and diagnosis of CSF rhinorrhea, how it's treated, and why it's so important to get symptoms evaluated promptly.

Man blowing his nose
George Clerk / Getty Images

CSF Rhinorrhea Symptoms

Signs of CSF rhinorrhea can be subtle. A runny nose that is clear and watery may be the first symptom of CSF rhinorrhea.

Other signs and symptoms may include:

  • Headache
  • Salty or metallic taste in the mouth
  • Drainage increases while leaning forward with the head down
  • Anosmia (lack of smell sensation)
  • Nasal congestion

These symptoms also occur with many other, more common conditions. However, given the potential complications of CSF rhinorrhea, you should not delay an evaluation if you experience them.

Causes of Cerebrospinal Fluid Rhinorrhea

A tear In the meninges or a fracture of bones in the region between the brain and the nasal cavities can allow CSF to leak from around the brain to the nostrils.

Some causes include:

  • Nasal sinus surgery
  • Developmental congenital abnormalities affecting the formation of the skull
  • An increase in intracranial pressure (ICP) 
  • Trauma to the head or face that causes a naso-orbito-ethmoid fracture or damage to the cribriform plate (a part of the "roof" of the sinus)
  • An object entering the upper nasal cavity (such as a nasal swab or a toy)

Spontaneous CSF rhinorrhea—that is, of unknown cause—is also possible.

The exact incidence of CSF rhinorrhea is unknown, but it is considered a rare complication of sinus surgery. Since the implementation of seat belt laws, the incidence of CSF rhinorrhea caused by trauma has also declined.


You should see a healthcare provider promptly if you have CSF rhinorrhea symptoms. If you have the symptoms after nasal surgery, you should call the surgeon who performed your procedure.

During your evaluation, you may be asked to perform a Smell Identification Test to determine if you have olfactory (smell) dysfunction.

Depending on your situation, your healthcare provider may also choose to perform an endoscopy. This involves using a tiny fiberoptic scope to visualize abnormalities in the superior nasal cavity and cribriform plate.

Tests that your healthcare provider may order include:

  • Computerized tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Β-2 transferrin assay (laboratory test on nasal drainage) to confirm whether the substance is, in fact CSF
  • Radioactive pledget scanning, an imaging test that involves inserting medical cotton in your nose and ears, followed by a lumbar puncture
  • Intrathecal fluorescein, which is an injection of dye into the fluid surrounding the spinal cord, can be used to both identify CSF leaks and to surgically repair them.

CSF rhinorrhea can be caused by a tear in the meninges, or tissues surrounding the spinal cord and brain, making those tissues susceptible to viruses and bacteria. When the meninges become swollen due to infection, meningitis occurs. Meningitis is a medical emergency. Symptoms of meningitis include:

  • Headache
  • Stiff neck
  • Sensitivity to light
  • Fatigue
  • Fever


If you have cerebrospinal fluid rhinorrhea, you must receive appropriate treatment to prevent meningitis, which can be a severe infection, and pneumocephalus (air in the cranial cavity).

Very small leaks may only require bed rest and medication to resolve. However, most cases of CSF rhinorrhea require surgery to repair the source of the leak. This is done by an otolaryngologist (ear, nose, throat specialist,

The type of surgery required will depend on the cause of your condition (surgery or trauma). The surgical success rate is good, though complications may occur with any surgical procedure.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ku J, Chen CY, Ku J, Chang HK, Wu JC, Yen YS. Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case. J Neurosurg Case Lessons. 2021 Oct 25;2(17):CASE21421. doi:10.3171/CASE21421

  2. Romeo D, Go BC, Ng JJ, Barrette LX, Rhodes IJ, Rajasekaran K. Systematic review: evaluating the efficacy of intrathecal fluorescein for localizing cerebrospinal fluid rhinorrhea. J Craniofac Surg. 2022 Nov-Dec 01;33(8):2581-2585. doi:10.1097/SCS.0000000000008849

  3. National Institute of Neurological Disorders and Stroke. National Institutes of Health. Meningitis.

  4. Abraham AP, Singh M, Reji KK, Nair S, Joseph M. Long-term follow-up of patients managed conservatively for acute traumatic CSF rhinorrhea. World Neurosurg. 2022 May;161:e564-e571. doi:10.1016/j.wneu.2022.02.065

  5. Liu MY, Woodworth BA, Kanaan A, Jang DW, Yao WC, Radabaugh JP, Gardner JR, Goros M, Grayson JW, Wang Z, Chen PG. SNOT-22 quality of life scores improve after endoscopic endonasal repair of spontaneous cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2022 Nov 14:34894221133769. doi:10.1177/00034894221133769

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.