Non-traumatic cerebrospinal fluid rhinorrhoea.

There is a certain degree of confusion in the literature concerning nasal leakage of cerebrospinal fluid when trauma is not the cause. The term 'spontaneous cerebrospinal fluid rhinorrhoea' has been used more or less consistently to describe such cases since 1899. Although isolated observations had been made earlier, it was the monograph by St. Clair Thomson (1899) that first clearly described and atttempted to define spontaneous cerebrospinal fluid rhinorrhcea as a clinical entity. Other authors have since essayed to subdivide this condition into 'primary spontaneous' or 'idiopathic' rhinorrhoea when a precipitating cause could not be found and 'secondary spontaneous' rhinorrhcea when a cause, usually a tumour, was discovered (O'Connell, 1964). Quite apart from the nosological adequacy of such a subdivision, the term 'spontaneous' cerebrospinal fluid rhinorrhoea itself would appear to be inexact, bearing no relationship to either the pathogenesis or natural history of the disease. The word 'spontaneous' means 'arising from natural impulse, without external stimulant, or having a self-contained cause or origin, or arising from or entirely determined by the internal operative or directive forces of the organism' (Shorter Oxford English Dictionary, 1962). It is our thesis that a careful study of the natural history of patients suffering such rhinorrhoea reveals no actual case which can fit such a definition-that is, in being truly 'spontaneous'. It would therefore be more accurate to describe all such cases, hitherto labelled spontaneous, by the more general term of non-traumatic cerebrospinal fluid rhinorrhcea. It is then possible to subdivide this category aetiologically on the basis of facts that emerge from a study of such patients, and assign each case according to the causative lesion. Quite apart from clarifying our understanding, this approach avoids what is essentially a 'waste-basket' category of 'primary spontaneous' rhinorrhcea, for those cases in which the true diagnosis has often not been discovered, as well as dispensing with the logic-