Abstract
The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.
Highlights
The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication
Fracture of the frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected (Fig 1). He underwent sinus wall repair and his extradural hematoma was drained through bifrontal craniotomy
Anterior skull base fractures include a significant number of injuries resulting in rhinorrhea from a Cerebrospinal fluid (CSF) fistula
Summary
Cerebrospinal fluid (CSF) rhinorrhea is the result of discontinuity of the anatomic borders between the meninges and the mucosa of the paranasal sinuses or nasal cavity. [1] The aetiology of CSF rhinorrhea can be classified as traumatic and non-traumatic, with traumatic aetiology subdivided into accidental and iatrogenic. [2] Traumatic CSF rhinorrhea is the most common, accounting for about 80-90% of all cases of CSF leakage. [2] Most leaks heal with conservative treatment over 7-10 days, with the stage commonly being lumbar drainage in cases where leaks do not heal. [3,4] On the other hand, some surgeons prefer to perform surgical repair of these patients.The risk of a recurrent leak after transcranial repair of traumatic CSF rhinorrhea has been reported to be 6%-32%. [4] The risk of meningitis persists as long as the CSF leak is active. Spontaneous recovery of post-traumatic cerebrospinal fluid rhinorrhea following meningitis... (2) Most leaks heal with conservative treatment over 7-10 days, with the stage commonly being lumbar drainage in cases where leaks do not heal. The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication.
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