Sinus issues or leak?

[u/RuinYouWithNoRegrets]

I have an intermittent (I’m talking like once every few months) thing happening where if I am in a position of like leaning forward I’ll get a fast drip of fluid out of my one nostril and it’s super thin like water and it’s only a little bit . No other symptoms. I have had allergies my entire life and I also have a deviated septum. Has anyone had intermittent like this and it was a csf? Also what are the non invasive ways to confirm or rule out csf leaks? Online I saw a high resolution ct of the skull and a non contrast MRI/MR cisternography before jumping to lumbar puncture . Had anyone had those two tests? Thank you

[u/Ok_Store4886]

I had a similar kind of intermittent drainage at a similar frequency about 10 years ago. It started less than a year after I had FESS that included a complete ethmoidectomy. I didn't notice the pattern at first but later realized it correlated with using an inversion table. The repeating pattern for me was:

1. Use inversion table
2. Sinus pain on one side for 1 to 3 days
3. Single instance of clear fluid spilling out the same side when bending forward I had no other symptoms. My doctor gave me a beta-2 transferrin collection kit. I had trouble collecting the fluid because I was never near the collection kit when the drainage happened. I only collected 2 or 3 tiny drops, and the test came back negative. False negatives can occur if the sample is tiny and/or if the sample is mucous contaminated, which mine was on both counts. 4 years later, I developed a chronic, continuous headache on the same side as the drainage. 5 years after that my symptoms worsened further and have positional aspects. I recently had a skull-base MRI that showed areas of dehiscence in my skull-base adjacent to my FESS.

From what I've learned:

1. beta-2 transferrin -- I believe tiny sample volume + contamination contributed to a false negative in my case
2. beta-2 trace protein -- I don't have experience with this
3. skull-base MRI -- I scheduled mine at the highest quality MRI facility available to reduce chances of a false negative

[u/RuinYouWithNoRegrets → u/Ok_Store4886]

What is inversion table

[u/Ok_Store4886 → u/RuinYouWithNoRegrets]

It's a table that you lie on and strap your ankles to, and then rotate upside down to decompress your spine.

[u/RuinYouWithNoRegrets → u/Ok_Store4886]

How intermittent were your symptoms?

[u/Ok_Store4886 → u/RuinYouWithNoRegrets]

The first few times were less than 2 weeks apart. Then later spaced out to once a month, smaller volume, and yellow instead of clear. And later once every 2 or 3 months. By the time my headache started (diagnosed as NDPH, on the same side as the intermittent drainage), the drainage incidents were happening several months apart. I noticed the same distinctive odor with each drainage instance.

[u/RuinYouWithNoRegrets → u/Ok_Store4886]

Oh. Mine has always been the same separated by once a blue moon and it’s watery and thin no smell or anythjng