Introduction: Meningoencephalocele is defined as brain tissue and meninges herniating beyond the bounds of the skull. This can often lead to CSF leak and when it occurs in the sinonasal region can be mistaken for other lesions. We report a rare case of a sinonasal meningoencephalocele manifesting with symptoms of nasal obstruction and provide an update on its treatment paradigm. Case Report: A 76-year-old male with a seizure disorder attributed to epilepsy had an incidental finding of a left ethmoid meningoencephalocele on CT scan. Retrospective analysis of his initial brain MRI from 2021 showed the lesion although it was not reported at the time. Subsequent CT scan repeated for seizures in December 2023 also showed left ethmoid sinus dehiscence and herniation, prompting ENT review. Further assessment revealed a history of chronic left sided nasal obstruction, clear rhinorrhoea and post-nasal drip. Literature Review: Review of the literature yielded only case reports and case series. Almost all reports are paedeatric congenital meningoencephaloceles. Treatment usually consists of surgery to prevent CSF leak and intracranial complications and in children to prevent cranial malformations, however in this case observation may be an appropriate course of action given the patients age.