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Can csf leak into the sinus cavities?
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Can csf leak into the sinus cavities?

My husband, 51, began having sinus-type headaches in June 2010. He reported no trauma to his head and was treated for a sinus infection. An MRI of his head showed all of his cavities filled with fluid. During July he began to slurr his words, lose balance and miss appointments. By mid August he was unable to work or drive, his short-term memory was severely affected and he was very lethargic and constantly sleepy.  His personality was changed also.  He now needs a walker and/or wheelchair because of balance, is fed through a feeding tube because he cannot swallow without the food or liquid going into his lungs.  He is also urinary incontinent.  
He was diagnosed with an autoimmune disorder, paraneoplastic syndrome positive for potassium channel antibody in October (no cancer detected).  He was treated with plasma pheresis and IVIg and high doses of steroids with no real improvement.  The doctors are now saying that the antibody was at a low level and did not cause these problems.
He has always had a low lying brain but pressure is normal (150) during lumbar puncture. He has continued with headaches which do go away when he lays down.  They tried one blood patch, he seemed to immediately improve, then reverted back. He had a cisternogram which was negative for leaks. Could he possibly have a spontaneous csf leak in his head and more than one blood patch could be needed?  Is possible to leak csf into the sinus cavities?  If so, is there a treatment for that?

Thank you for your attention.

Devastated and frustrated wife
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Hi,
How is your husband? The leakage of cerebrospinal fluid usually occurs when there is an abnormal connection between the CSF-containing space around the brain and the paranasal sinuses. This means that there has been a breakdown in the barrier that separates these two spaces. Posible causes of CSF leak include trauma and both brain and sinus surgery. In some patients, the CSF leak occurs spontaneously. Repair of CSF leaks in important to prevent meningitis and brain infection. CSF leaks can be closed by working through the nose and sinuses with endoscopic instruments or in lesser cases, open brain surgery. It is best that you talk to his doctors about his management plan. Take care and do keep us posted.
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