{'fraction_non_alphanumeric': 0.02171945701357466, 'fraction_numerical': 0.007239819004524887, 'mean_word_length': 5.213483146067416, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Severe Headache With Left Nasal Discharge: Is it Always Due to Autonomic Over Activity?

CASE DESCRIPTION A 40-year-old female presented with a 12month history of chronic daily left hemicranial headache and recurrent left sided nonpurulent nasal discharge. The headache was not throbbing, not associated with photophobia or phonophobia, but worsened when she stood up. There were no other features of autonomic dysfunction. She denied any trauma to her head or face. The nasal discharge was proven to be cerebrospinal fluid (CSF) after biochemical studies. The computed tomography (CT) of brain including myelogram showed complete opacification of the left sphenoidal sinus which was of water density. Magnetic resonance imaging (MRI) of the brain scan including cisternogram revealed a bony defect in the left middle cranial fossa along with a bulging meningocele into the left sphenoidal sinus. Also, there was contrast layering of the posterior ethmoidal sinus confirming CSF leak (see Figure). Spontaneous intracranial hypotension was diagnosed as per the proposed criteria of Schievink et al in 2011.