Signs in CSF Rhinorrhea | Halo Sign & Teapot Sign
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Signs in CSF Rhinorrhea
Two classical bedside signs are seen in CSF rhinorrhea. In this post, we will discuss:
- Halo Sign
- Teapot Sign
Halo Sign
📌 Type of Sign
👉 Clinical Sign
A bedside test performed in suspected CSF leak.
📌 Also Known As
👉 Double Ring Sign
👉 Target Sign
🔍 What is the Sign?
Halo Sign refers to the appearance seen when nasal discharge is dropped onto a filter paper, where the discharge is a mixture of CSF and blood.
A positive sign shows:
✅ Central dark red blood spot
✅ Peripheral outer clear ring of CSF
What is the reason behind the Halo sign seen in CSF leaks?
🎯 Why is it Called Halo Sign?
The appearance resembles a halo, with a double ring, hence the names Halo Sign, Double Ring Sign and Target Sign.
⚠️ Important Points
❌ Halo Sign is indicative of CSF, but it is not a definitive test
What is the Gold standard test to confirm a CSF leak?
What is the most common complication of untreated CSF rhinorrhea?
⚠️ Important MCQ Trap
Do not confuse the two Halo Signs:
| Halo Sign | Type | Seen In |
|---|---|---|
| Halo Sign on filter paper | Clinical | Suspected CSF leak |
| Halo Sign on CT Scan | Radiological | Cochlear otosclerosis |
Teapot Sign
📌 Type of Sign
👉 Clinical Sign
A bedside sign elicited by a change in posture.
🩺 How is it Elicited?
1- The patient is asked to sit upright
2- The patient then bends forward, with the head down
A positive sign is:
✅ Sudden gush or marked increase in clear watery nasal discharge
🧠 Why Does it Occur?
The sphenoid sinus ostium lies anterosuperior to the sinus floor.
On bending forward, CSF pooled in the sphenoid sinus gains easy access to the ostium, causing a sudden increase in discharge.
🫖 Why is it Called Teapot Sign?
The sudden increase in CSF leakage on bending forward resembles fluid pouring out of a teapot, hence the name Teapot Sign.
What is the radiological investigation of choice to localize the site of the CSF leak?
⭐ High Yield Rapid Revision Table
| Sign | Elicited By | Finding | Mechanism |
|---|---|---|---|
| Halo Sign | Dropping nasal discharge onto filter paper | Central dark red spot with an outer clear ring | CSF has lower viscosity and diffuses further than blood |
| Teapot Sign | Asking the patient to bend forward | Sudden gush of clear watery nasal discharge | Pooled CSF in the sphenoid sinus gains access to the anterosuperior ostium |
🧠 Viva Pearls
- Halo Sign is also known as the Double Ring Sign or Target Sign.
- Halo Sign shows a central dark red blood spot with a peripheral clear ring of CSF.
- Halo Sign is indicative but not definitive for CSF.
- A radiological halo sign is seen in cochlear otosclerosis, and should not be confused with the filter paper halo sign.
- Teapot Sign is a sudden gush of clear watery nasal discharge on bending forward.
- Teapot Sign occurs because the sphenoid sinus ostium lies anterosuperior to the sinus floor.
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