Recurrent Cerebrospinal Fluid Rhinorrhea Secondary to a Seizure-Induced Skull-Base Defect: An Unusual Complication of Epilepsy.

Abstract

Cerebrospinal fluid (CSF) rhinorrhea is a rare but serious condition that most commonly follows skull-base trauma or surgery, and its manifestation as a complication of epilepsy is exceptionally rare. Epilepsy management focuses on seizure control and prevention of immediate complications, such as status epilepticus or fall-related injuries. We describe a 36-year-old male with focal-onset epilepsy who developed recurrent CSF rhinorrhea temporally associated with nocturnal convulsions and a seizure-related cribriform-plate defect confirmed by magnetic resonance imaging and β-2 transferrin testing. We hypothesize that repeated minor cranial trauma and transient intracranial pressure surges during these seizures precipitated the skull-base defect. All alternative etiologies were systematically excluded; although a definitive causal link cannot be proven, the strong temporal association supports this hypothesis. The CSF leak was successfully addressed through endoscopic surgical repair, and preventive measures, including alterations to sleeping arrangements, were implemented. This case underscores the importance of considering CSF leakage in individuals with epilepsy presenting with unexplained nasal discharge, highlighting the need for enhanced seizure management, prompt recognition, and multidisciplinary care to prevent complications.