CASE REPORT   

Otorinolaringologia 2019 March;69(1):57-62

DOI: 10.23736/S0392-6621.18.02169-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Delayed unilateral cerebrospinal rhinorrhea caused by head trauma complicated with meningitis in patient with Klippel-Feil Syndrome

Martyna WANIEWSKA-ŁĘCZYCKA ¹ ✉, Eliza BROŻEK-MĄDRY ¹, Andrzej SOBIERAJ ², Antoni KRZESKI ¹

¹ Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland; ² Department of Neurosurgery, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland

Patients with unilateral watery nasal discharge and a history of head trauma should be suspected of CSF rhinorrhea. Proper diagnosis will avoid meningitis and other intracranial and life-threatening complications. The post-traumatic CSF leak that occurs 24 hours after an injury is the most common form of this pathology and represents up to 90% of all cases. Head trauma complicated by delayed cerebrospinal rhinorrhea is a rare pathology. Even more extremely rare is a CSF leak occurring after many years. Anterior ethmoid cells constitute the region most often exposed to a CSF leak. A cerebrospinal fluid leak requires appropriate diagnostic procedures and treatment. The patient presented in this paper was misdiagnosed and treated for many years for allergic rhinorrhea or chronic sinusitis and was only properly diagnosed when a complication occurred. In this case, the possibility of a CSF leak was additionally increased by Klippel-Feil syndrome. Meningitis with coexisting meningoencephalocele in the area of the posterior wall of the right frontal sinus and anterior ethmoid cells was diagnosed, and proper treatment was performed. CSF leak treatment should be interdisciplinary. A bifrontal open approach with a craniotomy is recommended in large skull-based multifocal fractures, especially including the posterior wall of the frontal sinus with coexisting dural fractures and central nervous defects. Unilateral watery discharge from the nose, especially with a history of head injury, should always prompt diagnostics for CSF leak.

KEY WORDS: Cerebrospinal fluid - Cerebrospinal fluid rhinorrhea - Craniotomy