October 2017

30y female with persistent rhinorrhea Trauma

History

30-year-old female who developed left sided rhinorrhea following an MVC in 2015.  She received minor head trauma without loss of consciousness.  She complains of intermittent dizziness without fevers, nuchal rigidity or photophobia.  She received a sinuplasty for presumed sinusitis without improvement.  

Exam

Awake, alert
Cranial nerves II-XII are intact
Strength- 5/5 upper extremities
No sensory loss
DTR within normal limits
Flexible endoscopy: generalized wetness in posterior nasal cavity increased with leaning forward.  No obvious masses or lesions.
 

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Questions

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Refrences:

  • Ziu M, Savage JG, Jimenez DF. Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures. Neurosurg Focus, 2012; 32(6):E3.
  • Komotar R, Starke R, Raper D, Anand V, Schwartz T.  Endoscopic Endonasal versus Open Repair of Anterior Skull Base CSF Leak, Meningocele, and Encephalocele: A Systemic Review of Outcomes.  J Neurol Surg A, 2013; 239-250.
  • Muscatello L, Lenzi R, Dallan I, Seccia V, Marchetti M, Sellari-Franceschini S. Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus. J Craniomaxillofac Surg. 2010;38(5):396-402.
  • Kwon JE, Kim E. Middle fossa approach to a temporosphenoidal encephalocele -technical note-. Neurol Med Chir (Tokyo). 2010;50(5):434-8.
  • Warnecke A, Averbeck T, Wurster U, Harmening M, Lenarz T, Stӧver T. Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas. Arch Otolaryngol Head Neck Surg, 2004;130(10):1178-84.

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