I have these drops of liquid trickling from my right nostril for the past week,” expressed Sheila, a concerned, visibly overweight 45-year-old business executive. She leaned slightly forward and bent her head to elucidate what she was saying. Crystal clear driblets trickled down, one every few seconds, like they do from a tightly shut, but slightly leaky tap, whose washer needs to be replaced. I collected a few bubbles in a sterile glass bottle to test. “Initially, I thought that this was just a runny nose, but then, I have no other symptoms apart from a headache and this just felt odd, so here I am,” she gestured with animated hands, in a way used by most people when something unexpected shows up.

“Do you feel a slight salty sensation at the back of your throat when you lie down?” I asked, to confirm my suspicion of this being no ordinary liquid, but sacrosanct cerebrospinal fluid (CSF). “Yes, yes, yes!” she interjected, relieved to know that I’d already diagnosed her problem. After a detailed assessment, I emphasised that she was lucky not to have had any fever; if the fluid got infected, it could lead to meningitis. I ordered a specialised MRI and CT scan to be able to exactly pinpoint the specific defect in the base of the skull from where the brain fluid was likely to be leaking from, and had her see me back at the earliest.