Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 964-966
DOI: 10.4103/ajns.AJNS_95_18
Case Report

Delay posttraumatic paradoxical cerebrospinal fluid leak with recurrent meningitis

Guive Sharifi
Department of Neurosurgery, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Seyed Mousavinejad
Department of Neurosurgery, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Hooman Bahrami-Motlagh
1   Department of Radiology, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Ali Eftekharian
2   Department of ENT, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Mohammad Samadian
Department of Neurosurgery, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Kaveh Ebrahimzadeh
Department of Neurosurgery, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
,
Omidvar Rezaei
Department of Neurosurgery, Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Cerebrospinal fluid (CSF) rhinorrhea complicates 2% of all head traumas, and 12%–30% of all basilar skull fractures. Posttraumatic CSF rhinorrhea usually occurs within the first 48 h, and majority of them occur in the first 3 months, whereas delayed CSF leak beyond 3 months is rare. On the other hand, CSF usually leaks through dural tearing associated with fracture of the anterior skull base. CSF leak through fractures of middle cranial fossa to the nose through the eustachian tube is very rare. We present a 52-year-old woman with delayed posttraumatic paradoxical CSF rhinorrhea and recurrent meningitis.

Key-words:

Basilar skull fractures - cerebrospinal fluid meningitis - leak - rhinorrhea

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg 2001;25:1062-6.
  • 2 Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr., Woodworth BA, Kennedy DW, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 2009;140:826-33.
  • 3 Linell EA, Robinson WL. Head injuries and meningitis. J Neurol Neurosurg Psychiatry 1941;4:23.
  • 4 Kamerer DB, Caparosa RJ. Temporal bone encephalocele – Diagnosis and treatment. Laryngoscope 1981;92:878-82.
  • 5 Rao K, Shukla D, Indira Devi B. Unusually delayed posttraumatic CSF rhinorrhea. Indian J Neurotrauma 2010;7:171-2.
  • 6 Iffenecker C, Benoudiba F, Parker F, Fuerxer F, David P, Tadié M, et al. The place of MRI in the study of cerebrospinal fluid fistulas. J Radiol 1999;80:37-43.
  • 7 Jones NS, Becker DG. Advances in the management of CSF leaks. BMJ 2001;322:122.
  • 8 Kerman M, Cirak B, Dagtekin A. Management of skull base fractures. Neurosurg Q 2001;12:23-41.
  • 9 Lopatin AS, Kapitanov DN, Potapov AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859-63.
  • 10 Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomás-Barberán M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277.
  • 11 Bhalodiya NH, Joseph ST. Cerebrospinal fluid rhinorrhea: Endoscopic repair based on a combined diagnostic approach. Indian J Otolaryngol Head Neck Surg 2009;61:120-6.
  • 12 Dalgiç A, Seçer M, Ergüngör MF, Okay HO, Uçkun O, Yıldırım AE. Traumatic posterior fossa epidural hematomas and their complications J Neurol Sci (Turkish) 2007;24:280-6.
  • 13 Talamonti G, Fontana RA, Versari PP, Villa F, D'Aliberti GA, Car P, et al. Delayed complications of ethmoid fractures: A “growing fracture” phenomenon. Acta Neurochir (Wien) 1995;137:164-73.
  • 14 Schneider RC, Thompson JM. Chronic and delayed traumatic cerebrospinal rhinorrhea as a source of recurrent attacks of meningitis. Ann Surg 1957;145:517.
  • 15 Uemura K, Makino H. Operative indication and operative method of frontal base skull fracture. Lewin's intradural patch. Shuju 1972;26:733-42.
  • 16 Merelli E, Merli GA, Sola P. An unusual method for diagnosing spinal fluid rhinorrhea in a case of delayed post-traumatic fistula. Ital J Neurol Sci 1982;3:249-50.
  • 17 Russell T, Cummins BH. Cerebrospinal fluid rhinorrhea 34 years after trauma: A case report and review of the literature. Neurosurgery 1984;15:705-6.
  • 18 Okada J, Tsuda T, Takasugi S, Nishida K, Tóth Z, Matsumoto K, et al. Unusually late onset of cerebrospinal fluid rhinorrhea after head trauma. Surg Neurol 1991;35:213-7.
  • 19 Pandya PM, Keogh AJ. Traumatic cerebrospinal fluid rhinorrhoea: A timely reminder. Injury 1991;22:492.
  • 20 Stewart BT, Kaye AH. Delayed cerebrospinal fluid rhinorrhoea: A case report. Aust N Z J Surg 1992;62:818-20.
  • 21 Crawford C, Kennedy N, Weir WR. Cerebrospinal fluid rhinorrhoea and haemophilus influenzae meningitis 37 years after a head injury. J Infect 1994;28:93-7.
  • 22 Salca HC, Danaila L. Onset of uncomplicated cerebrospinal fluid fistula 27 years after head injury: Case report. Surg Neurol 1997;47:132-3.
  • 23 Kamochi H, Kusaka G, Ishikawa M, Ishikawa S, Tanaka Y. Late onset cerebrospinal fluid leakage associated with past head injury. Neurol Med Chir (Tokyo) 2013;53:217-20.
  • 24 Guyer RA, Turner JH. Delayed presentation of traumatic cerebrospinal fluid rhinorrhea: Case report and literature review. Allergy Rhinol (Providence) 2015;6:188-90.