Focal atrophy is a diagnosis of exclusion in nontraumatic cerebrospinal fluid rhinorrhea. It is most commonly associated with ethmoid or sphenoid sinus defects and is most prevalent in women between the ages of 30 and 40 years. In the unique case described, a 39-year old woman had focal atrophy and cerebrospinal fluid rhinorrhea secondary to a sphenoid sinus defect. The defect was diagnosed by computed tomography scans and repaired neurosurgically.