ＭＲＩが有用であった小児外傷性髄液鼻漏の１例

Abstract

A 6-year-old boy diagnosed with posttraumatic rhinorrhea was successfully treated by recognition of the cerebrospinal fluid leakage pathway using magnetic resonance imaging (MRI). He fell down from the third floor. His consciousness deteriorated after admission due to the elevated intracranial pressure, and barbiturate therapy was performed. Transcranial Doppler sonography suggested hyperemia on the first day and vasospasm due to the traumatic subarachnoid hemorrhage on the fifth day after injury. Posttraumatic rhinorrhea appeared 12 hours after injury and gradually deteriorated. Moderate meningitis occurred, and antibiotic therapy was started. Right anterior cranial base fracture was detected by bone window CT. The axial view of conventional CT scan revealed pneumocephalus in the bifrontal lobe, traumatic subarachnoid hemorrhage in the right sylvian fissure and cerebral contusion in the right frontal region. The craniogram revealed bone fracture on the frontal base but did not show the fistula. MRI showed incarceration of the right rectal gyrus into the right ethmoid sinus and defect of the cortical substance of the frontal bone. Closure of the fistula and repair of the injured dura mater were performed on the sixth day, and bone defect in the right lamina cribrosa and incarceration of the rectal gyrus were recognized by MRI. His postoperative course was excellent. The rhinorrhea disappeared and the meningitis improved. He was discharged on the 34th day after the accident with no complaint except for right blindness due to optic canal fracture.