Is benign intracranial hypertension underdiagnosed in patients with spontaneous CSF leaks?
Reviewed by Sangeeta Maini and Bhaskar Ram

In ENT practice we come across spontaneous CSF leaks. Patients present either as unilateral watery rhinorrhoea or otorrhoea, or sometimes as hearing loss with a watery middle ear effusion. Clinicians, after confirming the diagnosis of CSF leak with beta 2 transferrin test, request a CT scan of the head/sinuses and MRI head scan with the aim to assess for any skull base defects and brain herniation. Surgeons then repair these leaks with either an endoscopic or an open approach. In some patients, repair fails repeatedly despite several attempts. One of the important causes of spontaneous CSF leak is benign intracranial hypertension (BIH). This condition is often under-diagnosed and undertreated. It is one of the important causes for failed CSF leak closures. Clinicians must therefore maintain a high index of suspicion and check for benign intracranial hypertension, especially when they come across CSF leaks in obese patients. The senior author nicely covers all clinic aspects of BIH, highlights a useful diagnostic criteria (Dandy and Freidman criteria) to make the diagnosis of BIH, and concludes with a useful management algorithm. We found this article useful and practical. We personally found the Dandy criteria straightforward and simple to remember.

Idiopathic Intracranial Hypertension Implications for the Otolaryngologist.
Pan DW, Vanstrum E, Doherty JK.
OTOLARYNGOL CLIN NORTH AM
2022;55(3):579-94.