[41M] With unilateral nasal drainage and history of strokes

Patient Description

A 41-year-old male presents with sudden onset of nasal drainage primarily from the right nostril, producing approximately 1.5ml of light yellow to clear fluid every 15 minutes for the past nine days. The patient reports no exacerbating or alleviating factors. He experiences headaches that improve when lying down and has felt nausea without vomiting. There are no changes in smell or taste, no recent head trauma, surgeries, sinus infections, or upper respiratory infections. The patient has a medical history significant for strokes and seizures secondary to strokes, and a vegetation around the heart, diagnosed in 2018. He denies any allergies, sinus issues, recent travel, or diagnostic imaging related to the current symptoms. Vital signs include a heart rate of 98 and blood pressure of 132/100. The patient tested negative for COVID-19 and does not have an elevated temperature.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Cerebrospinal Fluid (CSF) Leak: Given the sudden onset of clear nasal drainage primarily from one side, along with headaches that improve when lying down, a CSF leak is a possibility. This occurs when the fluid surrounding your brain leaks through a defect in the skull, often leading to clear nasal discharge. Nausea can also be associated with this condition.

    • Typical Testing and Treatment: Diagnosis often involves imaging studies like a CT or MRI scan, and sometimes a test to analyze the fluid. Treatment can range from bed rest and hydration to surgical repair, depending on the severity.
  • Sinusitis or Allergic Rhinitis: Although you haven't reported a history of allergies or sinus issues, these conditions can sometimes present with clear nasal drainage. However, they are less likely given the sudden onset and your specific symptoms.

    • Typical Testing and Treatment: These conditions are usually diagnosed based on symptoms and sometimes imaging. Treatment often includes decongestants, antihistamines, or nasal sprays.

Given your medical history of strokes and heart vegetation, it's important to consider these conditions in the context of your overall health.

What you can do

  1. Seek Medical Attention: It's important to consult a healthcare professional to evaluate your symptoms, especially considering the possibility of a CSF leak. They can perform the necessary tests and provide a formal diagnosis.

  2. Rest and Hydration: While waiting for medical evaluation, ensure you get plenty of rest and stay hydrated, as this can help alleviate some symptoms.

  3. Symptom Tracking: Use MDandMe to journal your symptoms, track any changes, and share this information with your healthcare provider. This can be helpful in managing your condition and providing insights to your doctor.

What you should look out for

  • Worsening Symptoms: If you notice an increase in the volume of nasal drainage, worsening headaches, or new symptoms such as vision changes or neck stiffness, seek medical attention promptly.

  • Signs of Infection: Although you don't have a fever, be vigilant for any signs of infection, such as fever or chills, which would require immediate medical evaluation.

Remember, while this information can be helpful, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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People Also Ask


What is a cerebrospinal fluid (CSF) leak and what are its symptoms?

A cerebrospinal fluid (CSF) leak occurs when the fluid surrounding the brain leaks through a defect in the skull, often leading to clear nasal discharge. Symptoms can include headaches that improve when lying down, nausea, and sometimes changes in vision or neck stiffness.


How is a CSF leak diagnosed and treated?

A CSF leak is typically diagnosed through imaging studies like a CT or MRI scan, and sometimes by analyzing the fluid. Treatment can range from conservative measures like bed rest and hydration to surgical repair, depending on the severity of the leak.


Can sinusitis or allergic rhinitis cause clear nasal drainage?

Yes, sinusitis or allergic rhinitis can cause clear nasal drainage, but they are less likely in this case due to the sudden onset and specific symptoms. These conditions are usually diagnosed based on symptoms and sometimes imaging, and treated with decongestants, antihistamines, or nasal sprays.


What should I do if I experience worsening symptoms or signs of infection?

If you experience worsening symptoms such as increased nasal drainage, worsening headaches, or new symptoms like vision changes or neck stiffness, seek medical attention promptly. Also, be vigilant for signs of infection like fever or chills, which require immediate medical evaluation.


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