Liquorrhea

Liquorrhea (from Latin liquor — fluid and Greek rhoia — flow) is a specific pathological condition arising from severe traumatic brain injury. It is characterized by the leakage of clear cerebrospinal fluid from the cranial cavity to the exterior due to direct mechanical damage to the bones and meninges.

Etiology and pathophysiology

The brain is constantly bathed in cerebrospinal fluid and is surrounded by three meninges (dura mater, arachnoid, and pia mater) that adhere closely to the inner cortical plate.

In fractures of the cranial base, sharp bone fragments can completely tear through the dura mater and arachnoid membranes.

As a result, an unnatural connection arises between the sterile internal environment of the skull and the external world. If the fracture line passes through the roof of the nasal cavity (ethmoid bone), the fluid begins to freely flow through the nasal cavity (nasal liquorrhea). In fractures of the temporal bone pyramid and damage to the tympanic membrane, fluid flows out of the ear (aural liquorrhea).

Clinical significance

The discharge of clear, watery fluid from the nose or ears following head trauma is an extremely serious symptom. In the pre-hospital stage, it is often identified by the “double spot” or “halo sign”: if a drop of discharge falls on a bandage, blood gathers at the center, surrounded by a broad clear halo of fluid.

The deadly danger of liquorrhea lies in the extremely high risk of developing purulent complications. Through the open channel, aggressive bacteria from the nasal cavity or ear can easily penetrate into the skull, causing fulminant purulent meningitis. Treatment begins with strict bed rest. If conservative approach is ineffective, a complex endoscopic surgery to perform cerebrospinal fluid fistula repair is required.