A patient who has undergone nasal hypophysectomy shows a nasal discharge. Which sign indicates cerebrospinal leakage?

• A. Dry mouth
• B. Rigidity of neck muscles
• C. Fall in blood pressure upon standing
• D. A yellow edge around nasal discharge

Answer: (D)

After nasal hypophysectomy, a discharge from the nose that indicates cerebrospinal fluid leak is typically more than just ordinary mucus. A sign to look for is a yellow-tinged edge around the nasal drainage. This halo effect happens because CSF contains glucose and, when it mixes with nasal mucus and any blood in the drainage, it forms a yellow ring around a clearer center. This is the best clue that the drainage is CSF rather than regular nasal mucus.

Other signs like dry mouth, neck rigidity, or a drop in blood pressure on standing point to dehydration, meningitis, or volume depletion, respectively, and are not specific indicators of a CSF leak. If CSF leakage is suspected, it’s important to notify the surgical team promptly and pursue confirmation and appropriate precautions to prevent infection.