Department of Neurology, University of Witwatersrand, Johannesburg, South Africa.
Br J Neurosurg. 2020 Oct;34(5):492-494. doi: 10.1080/02688697.2018.1478063. Epub 2018 May 28.
Post-traumatic CSF leaks are a complication in 2% of all head injuries. Majority of these patients will recover spontaneously. Whilst recent literature has predominantly centred on CSF leaks and their general investigations and management thereof, there is a paucity of information when it comes to those patients who have persistent post-traumatic CSF leaks, as well as the complication of recurrent meningitis. We present a patient with a persistent post-traumatic CSF leak who presented with recurrent bacterial meningitis thirteen times- the highest documented amount in an adult. We reviewed the literature with regards to the above as well. We reviewed a vast array of journal articles on the topic of CSF leaks from the PubMed resource, and focused this review specifically on those that documented patients who had uncorrected CSF leaks and their outcomes. Complications include meningitis and rhinorrhoea with brain abscesses and pneumocephalus occurring less frequently. Mortality has been documented to be 9% after 1 year. The rates of persistent CSF leaks were within the same range with an average calculated rate of 21%. Whilst meningitis was recorded and is common, it was not stipulated whether the incidences were recurrent. Post-traumatic persistent CSF leaks remain a therapeutic challenge and continued follow-up with early surgical intervention is highly recommended to prevent complications. One of the more serious complications of a persistent leak is meningitis. The long-term outcomes of recurrent meningitis could include cumulative focal neurological deficitis and cognitive impairment.
创伤后脑脊液漏是所有头部损伤的 2%的并发症。大多数患者会自发恢复。虽然最近的文献主要集中在脑脊液漏及其一般检查和管理上，但对于持续存在创伤性脑脊液漏的患者以及复发性脑膜炎等并发症的信息却很少。我们介绍了一位持续存在创伤性脑脊液漏的患者，他曾 13 次出现复发性细菌性脑膜炎，这是成人中记录到的最高次数。我们回顾了上述文献，并对脑脊液漏的相关文献进行了广泛的研究，特别关注那些记录了未经治疗的脑脊液漏患者及其结果的文献。并发症包括脑膜炎和鼻漏伴脑脓肿和空气性脑积水，这些情况较少发生。有文献记录显示，1 年后死亡率为 9%。持续脑脊液漏的发生率在同一范围内，平均计算的发生率为 21%。虽然脑膜炎有记录且常见，但并未说明其发生率是否为复发性。创伤后持续脑脊液漏仍然是一个治疗挑战，强烈建议持续随访并早期手术干预，以预防并发症。持续性漏的一个更严重的并发症是脑膜炎。复发性脑膜炎的长期后果可能包括累积局灶性神经功能缺损和认知障碍。
