Delay posttraumatic paradoxical cerebrospinal fluid leak with recurrent meningitis

Abstract

Cerebrospinal fluid (CSF) rhinorrhea complicates 2% of all head traumas, and 12%–30% of all basilar skull fractures. Posttraumatic CSF rhinorrhea usually occurs within the first 48 h, and majority of them occur in the first 3 months, whereas delayed CSF leak beyond 3 months is rare. On the other hand, CSF usually leaks through dural tearing associated with fracture of the anterior skull base. CSF leak through fractures of middle cranial fossa to the nose through the eustachian tube is very rare. We present a 52-year-old woman with delayed posttraumatic paradoxical CSF rhinorrhea and recurrent meningitis.

Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma

“…3,4 However, the presentation is usually early with more than 50% presenting within 48 h. Delayed presentations beyond a year are rare and are mostly limited to case reports. 7 Later presentations are associated with higher complication rates, especially of meningitis which can lead to significant morbidity and as in our case mortality. 5 Mechanisms for occurrence of delayed or occult leaks include (i) temporary closure of defect by herniation of brain matter in the foramina, (ii) resolution of edema later in the course of time, (iii) absorption of the hematoma plug that is initially sealing the foramen, (iv) contracture of scar tissue, or (v) tissue necrosis.…”

“… 3 , 4 However, the presentation is usually early with more than 50% presenting within 48 h. Delayed presentations beyond a year are rare and are mostly limited to case reports. 7 Later presentations are associated with higher complication rates, especially of meningitis which can lead to significant morbidity and as in our case mortality. 5 …”

“…5 Mechanisms for occurrence of delayed or occult leaks include (i) temporary closure of defect by herniation of brain matter in the foramina, (ii) resolution of edema later in the course of time, (iii) absorption of the hematoma plug that is initially sealing the foramen, (iv) contracture of scar tissue, or (v) tissue necrosis. 5,7 This may be missed many a time and often it is only after the development of complications like meningitis that CSF leaks are recognized. 3 A single institution-based review of 101 traumatic CSF leaks between 1984 and 1998 reported a 27.5% rate of occurrence of meningitis.…”

Management of Posttraumatic Cerebrospinal Fluid Leak with Secondary Diffuse Pneumocephalus Complicated by Meningitis and Communicating Hydrocephalus – Illustrative Case Report

“…The presentation typically occurs early, with most cases manifesting within the first 48 hours after the trauma or neurosurgical intervention [11,12]. It is possible to present later, but rhinorrhea beyond a year is rare [14]. Later presentations are associated with higher complication rates, including meningitis, which can lead to significant morbidity, as in the case demonstrated, as well as mortality [14].…”

A rare case of iatrogenic intracranial hypotension due to a minor CSF leakage

“…Iatrogenic IH can occur following the previous surgery or other procedures that invade the dura, such as the lumbar puncture or drain placement [ 1 , 2 ]. It is estimated that 16% of CSF leakages originated from recent surgical procedures [3] . Following a decrease in cerebrospinal fluid volume and intracranial pressure, complications such as subdural hematoma, subdural fluid collection, pituitary hyperemia, downward displacement of the brain hemispheres, and sagging of the cerebellum and brainstem may occur.…”