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case study: when a really runny nose is brain fluid
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a woman's constantly runny nose was misdiagnosed as allergies.
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kendra jackson assumed she was dealing with allergies or a lingering cold when she went to see yet another doctor for her perpetually running nose. the frustrated nebraska native needed another misdiagnosis like she needed a hole in the head.
“(it was) like a waterfall, continuously, and then it would run to the back of my throat,” she told ketv in 2018. “everywhere i went i always had a box of puffs, always stuffed in my pocket.”
jackson’s symptoms, which included constant migraines, began to appear a couple of years after she was rear-ended by another driver while sitting in her parked van in 2013. the impact sent her face into the dashboard and broke her shoulder in two places — injuries that would require multiple surgeries and a year’s worth of physical therapy to heal.
with doctors repeatedly pointing to an allergic reaction as the cause of her discomfort, jackson began to sink into depression, fearing she would never feel normal again. as she burned through box after box of tissues and routinely awoke in the morning drenched from the fluid seeping from her septum, the will to live was literally leaving her body. “i couldn’t sleep, i was like a zombie,” she said.
desperate for relief, jackson booked an appointment with an ear, nose and throat specialist at nebraska medicine and laid down the law upon arrival. “i said, ‘i am not leaving this office until you tell me what is wrong with me.’ i was adamant,” she said.
carla schneider, the attending physician’s assistant, told buzzfeed news it was clear almost immediately that jackson’s symptoms were far more serious than a common case of hay fever. “just based on her description of the amount of drainage she was having i knew that wasn’t normal and wasn’t typical for any type of allergic rhinitis.”
after consulting with christie barnes, the clinic’s specialist, they informed their patient of their stunning suspicion: cerebrospinal fluid was leaking out of her nose. the clear, colourless fluid that was making jackson’s life a living hell was supposed to be surrounding her brain and spinal cord, cushioning and protecting some of the body’s most delicate structures. “we keep it on the list for things to always consider,” schneider said. “even though it’s not very common, it is something that occurs.”
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the condition can present significant medical problems, particularly if bacteria or other pathogens manage to enter the brain through the opening the fluid is escaping from. the clinic sent a sample of the substance to a lab, which confirmed their suspicions, and gave jackson an mri to determine the exact source of the leak. they told her she had been losing around half a pint of cerebrospinal fluid a day — roughly half the amount of the vital substance the body produces daily.
in the past, treatment would have involved delicate brain surgery, but barnes was able to patch the hole in jackson’s head by going through her nose with the assistance of angled cameras and instruments. they used nasal mucosa — lining from the patient’s nose — to seal the opening they believe was caused by that fateful accident all those years ago.
“it’s likely that, with the impact of the car accident, she suffered an injury to the base of her skull,” schneider said. “allergic rhinitis will tend to involve both sides of the nose and typically there’s other associated allergy symptoms like sneezing, itchy, watery eyes and a sense of nasal congestion.”
cerebral spinal fluid leaks, on the other hand, are more localized and, for lack of a better word, abundant. “typically, the amount of fluid is copious,” she said. “it’s not just a little sniffle or trickle — you lean over to tie your shoes and you get a gush of fluid.”
with the surgery behind her, jackson has restored some sense of normalcy to her life, although she hasn’t been able to leave all of her symptoms in the past. “i don’t have to carry around the tissue anymore,” she said with a laugh. “and i’m getting some sleep. i feel better today than i did two and half years ago. i feel great.
“if i could get rid of the migraine headaches, i would feel awesome.”
dave yasvinski is a writer with healthing.ca
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