FRCS (ORL-HNS) · SECTION 1 SBA

Spontaneous CSF rhinorrhoea

An obese middle-aged patient has intermittent unilateral watery rhinorrhoea, an empty sella and a small lateral sphenoid encephalocele. What additional issue must be addressed when repairing the leak?

CHOOSE ONE ANSWER

Best of five

  1. A. Allergic rhinitis only
  2. B. Routine lumbar drain for every case
  3. C. Prophylactic antibiotics indefinitely
  4. D. Possible raised intracranial pressure
  5. E. No ophthalmic assessment
ANSWER AND REASONING

D. Possible raised intracranial pressure

Spontaneous leaks commonly coexist with raised pressure; ignoring it increases recurrence risk even after technically sound closure.

Why every option is right or wrong

A. Allergic rhinitis only: The imaging and unilateral leak require skull-base evaluation.

B. Routine lumbar drain for every case: Drainage is selective and does not replace closure or long-term pressure assessment.

C. Prophylactic antibiotics indefinitely: They do not close the defect and are not a durable prevention strategy.

D. Possible raised intracranial pressure: Spontaneous leaks commonly coexist with raised pressure; ignoring it increases recurrence risk even after technically sound closure.

E. No ophthalmic assessment: Symptoms/signs of intracranial hypertension and visual risk may require neuro-ophthalmic input.

What if the scenario changed?

If fever, meningism or confusion developed, emergency meningitis management would take priority over elective pressure work-up.

EDUCATIONAL USE

Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.

Back to the Section 1 bank