Alsulaiman Feras
Department of Neurology, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Int Med Case Rep J. 2025 Jun 15;18:713-718. doi: 10.2147/IMCRJ.S528739. eCollection 2025.
Cerebrospinal fluid (CSF) rhinorrhea is a rare but serious condition that most commonly follows skull-base trauma or surgery, and its manifestation as a complication of epilepsy is exceptionally rare. Epilepsy management focuses on seizure control and prevention of immediate complications, such as status epilepticus or fall-related injuries. We describe a 36-year-old male with focal-onset epilepsy who developed recurrent CSF rhinorrhea temporally associated with nocturnal convulsions and a seizure-related cribriform-plate defect confirmed by magnetic resonance imaging and β-2 transferrin testing. We hypothesize that repeated minor cranial trauma and transient intracranial pressure surges during these seizures precipitated the skull-base defect. All alternative etiologies were systematically excluded; although a definitive causal link cannot be proven, the strong temporal association supports this hypothesis. The CSF leak was successfully addressed through endoscopic surgical repair, and preventive measures, including alterations to sleeping arrangements, were implemented. This case underscores the importance of considering CSF leakage in individuals with epilepsy presenting with unexplained nasal discharge, highlighting the need for enhanced seizure management, prompt recognition, and multidisciplinary care to prevent complications.
脑脊液鼻漏是一种罕见但严重的病症，最常见于颅底创伤或手术后，而其作为癫痫并发症的表现极为罕见。癫痫管理的重点是控制癫痫发作和预防直接并发症，如癫痫持续状态或跌倒相关损伤。我们描述了一名36岁的局灶性发作癫痫男性患者，他出现了反复的脑脊液鼻漏，在时间上与夜间抽搐相关，磁共振成像和β-2转铁蛋白检测证实存在与癫痫发作相关的筛板缺损。我们推测，这些发作期间反复的轻微颅脑创伤和短暂的颅内压波动促成了颅底缺损。所有其他病因均被系统排除；尽管无法证实明确的因果关系，但强烈的时间关联支持这一假设。通过内镜手术修复成功解决了脑脊液漏问题，并实施了包括改变睡眠安排在内的预防措施。该病例强调了在出现不明原因鼻分泌物的癫痫患者中考虑脑脊液漏的重要性，突出了加强癫痫管理、及时识别和多学科护理以预防并发症的必要性。
