Department of Medicine, Manipal University Kasturba Medical College, Karnataka, India.
Korean J Intern Med. 2012 Sep;27(3):350-2. doi: 10.3904/kjim.2012.27.3.350. Epub 2012 Sep 1.
An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.
本文报道了一例中年女性患者，以水样鼻漏 1 周，伴头痛、呕吐和发热 1 天为主诉。神经系统检查发现脑膜刺激征和双侧视乳头水肿。CSF 检查提示化脓性脑膜炎，头颅 CT 显示有脑积气。鼻内镜检查显示左侧嗅裂处硬脑膜外膨，有 CSF 漏和颗粒状鼻黏膜。该缺损通过手术修复，该区域的活检显示提示结核的肉芽肿性改变。患者经标准四联抗结核治疗后完全康复。据我们所知，以前尚未报道过继发于鼻结核的自发性 CSF 鼻漏伴脑积气。
