Ulrich Michael T, Loo Lawrence K, Ing Michael B
Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Infectious Diseases Section, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA, USA.
Case Rep Med. 2017;2017:9012579. doi: 10.1155/2017/9012579. Epub 2017 Jul 26.
Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication of the dura mater to the nasal mucosa. The majority of cases of CSF rhinorrhea are the result of trauma or surgery involving the skull base. Spontaneous CSF rhinorrhea is a rare clinical entity with increased risk of ascending infection. Delay in diagnosis places the patient at risk of developing meningitis.
A 36-year-old African American female with significant medical history of obesity and hypertension presented to the emergency department with headache, altered level of consciousness, fever, and neck stiffness. Previously, the patient was diagnosed with chronic allergic sinusitis by multiple providers. Physical exam findings and laboratory tests were consistent with bacterial meningitis. The patient was admitted and started on appropriate antibiotic therapy. The patient continued to complain of persistent unilateral clear nasal drainage. The initial report from the computerized tomography scan of the sinuses indicated findings consistent with chronic sinusitis. Magnetic resonance imaging of the orbits revealed findings consistent with CSF rhinorrhea. Otolaryngology was consulted for surgical intervention.
Suspected CSF rhinorrhea should prompt immediate biochemical and radiologic evaluation and surgical consultation. CSF rhinorrhea places patients at risk of developing bacterial meningitis.
脑脊液鼻漏是由于硬脑膜与鼻黏膜之间出现异常连通所致。大多数脑脊液鼻漏病例是由涉及颅底的外伤或手术引起的。自发性脑脊液鼻漏是一种罕见的临床病症，上行感染风险增加。诊断延迟会使患者面临发生脑膜炎的风险。
一名36岁的非裔美国女性，有肥胖和高血压的重要病史，因头痛、意识水平改变、发热和颈部僵硬前往急诊科就诊。此前，多名医生诊断该患者患有慢性过敏性鼻窦炎。体格检查结果和实验室检查与细菌性脑膜炎相符。患者入院并开始接受适当的抗生素治疗。患者持续抱怨单侧鼻腔持续流出清亮液体。鼻窦计算机断层扫描的初步报告显示结果与慢性鼻窦炎相符。眼眶磁共振成像显示结果与脑脊液鼻漏相符。咨询耳鼻喉科进行手术干预。
怀疑脑脊液鼻漏应立即进行生化和影像学评估以及手术会诊。脑脊液鼻漏会使患者面临发生细菌性脑膜炎的风险。
