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When A Runny Nose Is Brain Fluid Leaking: Here Is What To Do

Most cases of runny noses are not from central spinal fluid (CSF) leaks. (Photo: Getty Images)

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It's not snot. It's leaking brain fluid.

That's what Greg Phillpotts learned after suffering from a runny nose for 5 years, as described by Josh Chapin for ABC 11 Eyewitness News. Here's a Tweet from Chapin:

It turned out that Phillpotts was not experiencing constant allergies as he had been told previously. Instead, cerebral spinal fluid (CSF) was leaking out into his nose. CSF is a fluid that surrounds your brain and spinal cord, cushioning, protecting, and supporting those parts of the body. CSF is one of the reason your brain doesn't land with a thud every time you do a jumping jack or listen to Metallica. Normally, the membranes keep the CSF contained, a bit like a big water balloon around your brain and spinal cord. However, anything that may damage the membranes, such as a head injury, surgery, or a tumor, may leave a hole though which the fluid can leak out, potentially into your nose or ear.

Here's a TODAY show segment about another person who had a somewhat similar experience:

As you can see, such a condition can go misdiagnosed for years. That's because "brain fluid leaking" is usually not the first thing you think about when you have a runny nose. Usually, it's a cold, the weather, allergies, cheap cologne, watching too many rom-com movies, or that darn cat. After all, the condition is very rare. However, consider the possibility of a CSF leak if you find the following:

The fluid only comes out of only one nostril or one ear. Allergies tend to be more equal opportunity and affect all of your nasal passages or both your ears.

The leakage lasts for a long time. A cold or the effects of a romantic comedy should not last for several years at least not continuously.

Tilting your head forward or straining makes the drainage worse. This could make toilet trips particularly fun.

The drainage started after head trauma or surgery. There isn't always a clear cause of the defect or drainage but check what you were doing before the drainage started.

The drainage doesn't change with the seasons or location. Allergy symptoms may improve the farther you stay away from Mr. Bigglesworth but a CSF leakage won't.

The volume of drainage is more than you would expect from a cold or allergies. If you wake up and find your shirt or pillowcase soaked that is more than you may expect from allergies or an infection.

You have accompanying headaches or changes in vision or hearing. A classic symptom is a headache that improves when you lie down. While such symptoms can occur with other conditions, they should warrant further exploration.

As the Cleveland Clinic describes, your doctor can test for a CSF leak by having you lean forward to see if the drainage increases, using a scope to examine your nasal passages, ordering imaging like a CT or MRI, and testing the fluid to see if it resembles CSF. If a CSF leakage has started recently, your doctor may recommend a more conservative approach, giving the defect time to heal on its own. This means staying in bed for a week or 2 and avoiding movements that may keep the defect from healing coughing, sneezing, straining, or laughing. Therefore, you may want to take stool softeners and limit your television watching to C-SPAN.

If conservative approaches don't resolve the leakage, surgery may be in order. Depending on where the defect is located, your doctor may be able to fix it with using a scope.

You don't want to let a CSF leakage go on without fixing it. As one of the surgeons says on this segment of the television show Botched, "brain fluid coming out of the nose is a major concern":

There are very few sentences with the words "brain" and "coming out of the nose" that should not raise concern. Any defect in the membranes surrounding and protecting the brain and spinal cord can serve as a revolving door for bacteria and other microbes. Such microbes can cause very serious and life-threatening infections such as meningitis. Moreover, CSF leaks can progress to more debilitating symptoms such as severe headaches or be the sign of a more serious problem such as a tumor.

As KidsHealth has pointed out, there's an old joke that says if your nose is running and your feet smell, you must be upside down. Well, if your nose keeps running for weeks or months, see your doctor because something doesn't smell right.

What Will Cure My Daughter's Constantly Runny Nose?

Enlarged adenoids can certainly cause the kind of problems you describe your daughter as having. Like the tonsils, the adenoids are swellings of special lymph tissue and act as a defence against disease. They sieve the blood for germs which threaten to infect the body as they are breathed in through the nose and mouth. The tonsils guard the throat and the adenoids guard the nose.

Children under the age of five often have large tonsils and/or adenoids because at this age they are naturally exposed to potentially harmful viruses and bacteria that they have not met before through contact with other children in particular. Such enlargement of the tonsils and adenoids is usually a good sign that they are working well to fight off infection. However sometimes they can become so large that they cause problems in themselves by blocking off parts of the upper respiratory tract.

If the adenoids become too large they can block the upper part of the nostrils (the naso pharnyx). This can prevent nasal discharge from flowing down the back of the nose into the throat and cause it to pour out of the nostrils causing the persistent discharge you describe in your daughter. This nasal discharge is more likely to become infected making it green and sometimes making the skin around the nose sore.

Large adenoids can also affect movement of the soft palate making speech sound 'nasal' and can cause snoring at night.

They can also block off the Eustachian tube which equalises pressure between the middle ear and the back of the throat leading to recurrent ear infections and / or glue ear which can reduce hearing. Sometimes the problem can be improved with antibiotics and perhaps a low dose steroid nose spray. Your GP can decide if these will help.

If the problem persists your GP can refer your daughter to an ear, nose and throat surgeon who can assess whether her adenoids are significantly enlarged and how much they are contributing to her problems. The surgeon can then advise you whether she needs surgery to remove the adenoids.

The surgeon will also check her ears and tonsils. Her tonsils may be enlarged but they are usually only removed if they are so big that they interfere with swallowing and therefore eating or it they block off breathing at night. In both these circumstances they will stop a child growing as well as expected and treatment is needed.

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ADHD: 'The Web Comics That Show What My Life Is Like'

By Dhruti ShahBBC News

Dani Donovan's ADHD comics have tapped into a significant fan base

When Dani Donovan wanted to show her colleagues what life was like for her as someone diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), she never thought her sketches would lead to a series of web comics with a celebrity fan base.

The 28-year-old, who lives in Omaha, Nebraska, was diagnosed about a decade ago with ADHD and now hopes her comics will help others to understand the challenges for those with the condition.

She told the BBC: "I'd just started a new job working in data visualisation, and it was the first time I was able to be really open about having ADHD and talk to my colleagues about what it's like.

Dani is now working on an idea for a book

"We were telling stories and joking about how I always get off track while I'm telling stories, and I said that it's very much like having a sleepy train conductor running my train of thought. I had the idea for a flowchart, I posted it on Twitter and it took off immediately."

Her graphic shows that when she hears non-ADHD storytelling, it involves a straight move from the start of a story to the end. Her storytelling, however, involves a pre-story prologue before moving to the start of the story, and then wandering through 'too many details', a side-story and losing her train of thought before reaching the end of the tale - and then apologising.

Dani's attempt to explain her meandering thought process became a viral hit

However, as with all things that hit the internet - once it's let loose, be careful of memes and amendments.

Dani's diagram was re-versioned by an unknown person who split the flowcharts and created a meme with 'How a normal person tells a story' taking the place of the 'Non-ADHD Storytelling' heading Dani had given her first flowchart, and 'How I tell a story' replacing the 'ADHD Storytelling' heading for the meandering flowchart.

The experience hit a chord and became a viral hit. Actress and writer Mindy Kaling even posted the meme stating "I feel attacked".

More than 4,200 people liked this image Dani posted on Instagram of 'Hard to swallow pills'

Dani says she was a little bit disheartened when the storytelling version with the ADHD element stripped out exploded in the social sphere, as her watermark had been stripped off and the fonts had changed.

"When you're a graphic designer, it just hurts your heart - at least use a good font.

"I had also made a deliberate choice not to water down my images to try to appeal to lots of people, because I wanted people with ADHD to be heard."

She said as the image resonated so much, she decided to pull together many more.

Dani says that ADHD can mean it can be a struggle to start projects or even basic habits

"I wanted people to know that this is my experience, this is how ADHD affects me. I'm not saying that most people experience this, but it's been nice hearing from people who don't have ADHD but do relate to the pictures, as well as people who have it, or have loved ones who have been diagnosed.

"It's when they go 'Wow, this really helps me understand it a lot better' or 'Wow, I didn't know we had so much in common.'

"I've had people reach out to me and message me to tell me that when they looked at the whole range of experiences in the series, they related to every single one and sought out a therapist. Some of them got diagnosed and are being treated."

Dani's art helps her to process own thoughts and feelings about life with ADHD - she's a big fan of art therapy

However, Dani is quick to stress that the images are not a diagnostic tool, and shouldn't be considered as such.

"If people ask me, 'Does this mean I have ADHD?' my answer is always going to be 'No, it definitely doesn't, but if you've read through the entire body of work and you feel every single thing hits home or if you are crying because you've got so many different experiences and haven't been understood, then you should think about speaking to a doctor or someone else.'

The comments on Dani's Instagram account highlight how her sketches resonate with many

"Being able to have these open conversations, especially in the workplace, is one of the biggest areas where people can struggle. I'd like to be able to help with that. I'd like my graphics to help people to understand their children a bit better too."

Dani says one of her biggest fears was showcasing her images to the world: "The larger the audience gets, the more criticism will happen. I was worried about people saying 'Everybody's like this, you know - don't blame it on your ADHD' or 'Everybody's a little ADHD and you're lazy or making excuses'. People with the diagnosis hear that a lot already.

"But I've mainly had positive feedback. There are a lot of supportive people out there who are getting involved in the conversation and saying that this is part of a larger body of work - one graphic doesn't tell the whole story."

All images courtesy of Dani Donovan

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Running Nose Like Water