Although the COVID-19 pandemic has lost its strength, it persists. The importance of diagnosis in the control of this pandemic has been demonstrated. The naso/oro-pharyngeal swab test is still used more frequently for sample collection in COVID-19 due to its high sensitivity and specificity. 1 The complication rate for the nasopharyngeal swab collection technique is extremely low in the literature. Non-life-threatening complications, such as nonsevere epistaxis, are observed frequently, but broken swab sticks in the nasal cavity and stomach have also been reported on rare occasions. 2 It should be stated that another important complication for the medical profession is aerosol generation during the sampling process.In addition to the above-mentioned low-risk complications, serious life-threatening complications may be observed in the literature, including the aspiration of a broken swab stick during the collection of samples from the tracheotomy tube. Cases of CSF rhinorrhea (similar to the present case) after the sampling process have also been reported in the literature. [3][4][5] The authors stated that encephalocele was reported in the first and second cases. 3,4 In the third case, meningitis due to CSF leakage after swab testing was seen and CSF rhinorrhea was stopped after empirical antibiotics treatment. 5 In the present case, CSF rhinorrhea that appeared immediately after sampling was observed, and it is noteworthy that the patient's radiological images did not have any findings compatible with any encephalocele or similar.Sampling with a nasopharyngeal swab for COVID-19 is the most important step for obtaining accurate results in the diagnosis of COVID-19. The most important condition for sampling from the nasopharynx by the transnasal route is to know nasal anatomy well. The situation that should be kept in mind is the fact that the swab stick, after passing through the nostril and advancing parallel and close to the nasal floor, safely reaches the nasopharynx. One of the appropriate methods for assessing whether the nasopharynx has been reached is to evaluate the distance. The distance from the nostril to the external ear canal entrance should be kept in mind as an easy method that roughly shows how far the distance from the nostril to the nasopharynx might be. In cases where the distance cannot be covered, intranasal pathologies should be considered, and it might be safer to try sampling from the other nasal cavity. CONCLUSIONWhen the literature is examined, the rate of life-threatening complications is quite low. Sampling should be performed by an experienced health care worker to reduce the rate of serious complications, anatomical variations should be considered, and sampling should be done at an angle appropriate to the anatomy.

Introduction Different combinations of medications are utilized during wrist access for radial artery (RA) or ulnar artery (UA) catheterization in neuroendovascular procedures to preclude vasospasm. These “cocktails” commonly include the calcium channel blocker Verapamil, without established benefit. We analyze outcomes in patients with and without Verapamil in their “cocktail” by using a case-control cohort of our single-center experience. Methods A prospective log of consecutive patients who underwent diagnostic cerebral angiograms using RA/UA access was retrospectively reviewed, and patients were grouped into Verapamil and non-Verapamil cohorts. The primary outcomes assessed were the presence of forearm skin rashes (hives) and RA/UA spasms. Our initial management included Verapamil (5 mg) in the cocktail, but Verapamil was removed after we noticed the development of hives in multiple patients immediately following its injection. Results A total of 221 patients underwent 241 RA/UA diagnostic cerebral angiograms and were included in our analysis. One hundred and forty-nine patients (61.8%) underwent catheterization with Verapamil and 92 (38.2%) were catheterized without it. Four of the 149 patients in the Verapamil group (2.7%) developed hives during the procedure and were treated with Benadryl (25 mg). Of the 92 patients who did not receive Verapamil, there were zero (0%) cases of hives and one (1.1%) case of vasospasm. Conclusion Verapamil in the “cocktail” for wrist access diagnostic cerebral angiograms was associated with periprocedural hives, but not associated with a significant reduction in spasm compared to the non-Verapamil group. Our findings suggest that the administration of prophylactic Verapamil for these procedures may not be necessary.