scholarly journals A Rare Case of Spontaneous Pneumocephalus Associated with Nontraumatic Cerebrospinal Fluid Leak

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Murad Baba ◽  
Omer Tarar ◽  
Amer Syed
Keyword(s):  
Cerebrospinal Fluid ◽  
Idiopathic Intracranial Hypertension ◽  
Sphenoid Sinus ◽  
Rare Case ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Bony Defect ◽  
History Of ◽  
The Right ◽  
Fluid Leak

Introduction. Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions. We report a rare case of spontaneous pneumocephalus associated with CSF leak secondary to right sphenoid sinus bony defect without history of trauma.Case Description. 51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri) presented to the emergency room complaining of headache and clear discharge from the right nostril. Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Computed Tomography (CT) scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus. CT scan of facial bones showed bony defect along the right sphenoid sinus with abnormal CSF collection. The patient was started on intravenous antibiotics for meningitis prophylaxis and subsequently underwent transsphenoidal repair of cerebrospinal fluid leak with abdominal fat graft. CSF rhinorrhea stopped completely after the surgery with near complete resolution of pneumocephalus before discharge.Conclusions. Early identification of pneumocephalus and surgical intervention can help decrease the morbidity and avoid possible complications. Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

Cerebrospinal fluid leak with recurrent meningitis following tonsillectomy

2010 ◽  
Vol 5 (3) ◽  
pp. 302-305 ◽  
Author(s):  
Shawn L. Hervey-Jumper ◽  
Ahmer K. Ghori ◽  
Douglas J. Quint ◽  
Lawrence J. Marentette ◽  
Cormac O. Maher
Keyword(s):  
Cerebrospinal Fluid ◽  
Unusual Case ◽  
Posterior Pharyngeal Wall ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Petrous Apex ◽  
Recurrent Meningitis ◽  
Pharyngeal Wall ◽  
History Of ◽  
Fluid Leak

The authors report an unusual case of bilateral large petrous apex cephaloceles in a 14-year-old boy with a history of recurrent meningitis. Although these lesions are rare and usually asymptomatic, surgical correction is recommended if they are associated with a persistent CSF leak. In this patient, the extensive bilateral cranial defects were not adequately treated by an intracranial approach alone. Repair of a defect in the posterior pharyngeal wall, the site of a prior tonsillectomy, ultimately resulted in repair of the CSF fistula.

scholarly journals Ehlers Danlos, POTS, and Occult Cerebrospinal Fluid Leak: A Case Report

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Mri Imaging ◽  
Epidural Blood Patching ◽  
Blood Patch ◽  
History Of ◽  
Fluid Leak

Ehlers Danlos syndromes (EDS) are associated with spontaneous intracranial hypotension (SIH) and postural orthostatic tachycardia syndrome (POTS). We hypothesized that some POTS patients might in fact have occult SIH due to unappreciated EDS. We describe a 26-year-old female with a history of POTS and headache who presented to us with negative imaging for cerebrospinal fluid leak (CSF). Upon examination with clinical evidence of EDS and supportive history, we performed an epidural blood patch despite repeat imaging evidence negative for CSF leak resulting in resolution of the patient’s POTS, headache, and cognitive symptoms. Patients with POTS and connective tissue disorders associated with dural weakness may be suffering from occult chronic CSF leaks. MRI imaging may be falsely reassuring and dissuade clinicians from performing epidural blood patching among patients who can be cured.

scholarly journals Spontaneous Cerebrospinal Fluid Leak Presenting as Unilateral (Left-sided) Middle ear Effusion

2008 ◽  
Vol 87 (2) ◽  
pp. 79-80 ◽  
Author(s):  
Kavadi T. Rajkumar ◽  
Ahmed A. Orabi ◽  
Michael S. Timms
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Ear ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Middle Ear Effusion ◽  
Presenting Symptoms ◽  
Single Defect ◽  
The Right ◽  
Fluid Leak ◽  
Ear Effusion

Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear occurs rarely and can easily be missed, especially in adults. Although the presenting symptoms can be subtle, early suspicion and confirmatory imaging can establish the diagnosis. Most previously reported cases of spontaneous CSF leak into the middle ear occurred on the right side. We report a case of left-sided single-defect spontaneous leak.

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Marcos Vilca ◽  
◽  
Carlos Palacios ◽  
Sofía Rosas ◽  
Ermitaño Bautista ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Skull Base ◽  
Rare Complication ◽  
Cerebrospinal Fluid Leak ◽  
Standing Position ◽  
Csf Leak ◽  
Skull Base Fracture ◽  
Timely Diagnosis ◽  
The Right

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

scholarly journals Repair of encephalocele and cerebrospinal fluid leak with the use of bone morphogenetic protein: A case report

2019 ◽  
Vol 10 ◽  
pp. 55 ◽  
Author(s):  
Dejan Slavnic ◽  
Doris Tong ◽  
Ryan Barrett ◽  
Teck-Mun Soo
Keyword(s):  
Cerebrospinal Fluid ◽  
Bone Morphogenetic Protein ◽  
Protein A ◽  
Retrospective Chart Review ◽  
Standard Technique ◽  
Cerebrospinal Fluid Leak ◽  
Sudden Onset ◽  
Csf Leak ◽  
Bony Defect ◽  
Morphogenetic Protein

Background: Encephaloceles are rare phenomena which occur when brain parenchyma herniates through a skull defect which, if left untreated, may lead to significant issues such as cerebrospinal fluid (CSF) fistulas, meningitis, and intractable seizures. Due to the rarity and variety in size and location of encephaloceles, no standard technique has been established for the resultant defect. Herein, we demonstrate the safe and effective use of bone morphogenetic protein (BMP) in the repair of CSF leak caused by encephalocele. Case Description: A retrospective chart review was conducted on a 50-year-old female who presented with sudden onset spontaneous right nostril CSF leak due to the right lateral sphenoid sinus recess encephalocele, for which she underwent surgical repair. After resecting the encephalocele, cadaver crushed bone was used to fill the skull base defect. Following, an absorbable sponge from the extra-small BMP kit was cut in half and soaked with recombinant human BMP-2 (rhBMP-2) before being laid over the bony defect. On postoperative clinic visits at 2 weeks and at 3 months, the patient demonstrated good recovery without evidence of recurrent CSF leak. On follow-up computed tomography imaging at 9 months’ postsurgery, there was no evidence of recurrent CSF leak or encephalocele, infection, ectopic bone formation, excessive inflammation, or neoplasm. Conclusion: In this case, we demonstrate the successful use of BMP for the repair of CSF leak due to encephalocele. It is our extrapolation that the pro-inflammatory properties of rhBMP-2 lead to the prevention of recurrent CSF leak.

Cranio-cervical junction cerebrospinal fluid leak after microdebrider-assisted adenoidectomy – A rare case report

2018 ◽  
Vol 69 (1) ◽  
pp. 53-55
Author(s):  
Karthikeyan Ramasamy ◽  
Hemanth Vamanshankar ◽  
Sunil Kumar Saxena ◽  
Vignesh Karunakaran ◽  
Arun Alexander
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Rare Case ◽  
Cerebrospinal Fluid Leak ◽  
Rare Case Report ◽  
Fluid Leak

Sternberg's Canal and Defect: Is the Lateral Craniopharyngeal Canal a Source of Spontaneous Cerebrospinal Fluid Leak? Anatomic and Radiological Analysis in Pediatric and Adult Populations

2021 ◽  
Author(s):  
Adedamola Adepoju ◽  
Lucas P Carlstrom ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Carlos Diogenes Pinheiro-Neto ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adult Population ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Superior Orbital Fissure ◽  
Old Patients ◽  
Visual Illustration ◽  
Craniopharyngeal Canal ◽  
High Incidence ◽  
Fluid Leak

Abstract BACKGROUND The lateral craniopharyngeal or Sternberg's canal (SC) originates from superior orbital fissure (SOF) and traverses the sphenoid body into the nasopharynx. A remnant of the canal, Sternberg's defect (SD), has been debated as a source of cerebrospinal fluid (CSF) leak. The canal was described in 1888, and there is limited accurate visual illustration in the literature. OBJECTIVE To provide a detailed anatomic and radiological illustration of the canal in pediatric and adult population including the mechanism undermining the incidence of the canal, and the possibility of the canal as a source of CSF leak. METHODS A total of 195 high-resolution computed tomographies (CT) of patients (50 3-yr-old, 20 5-yr-old, and 125 adults) and 43 dry adult skulls (86 sides) were analyzed for a canal matching the description of the SC. RESULTS A SC was identified in 86% of the 3-yr-old and 40% of 5-yr–old patients. The diameter and length were 2.12 mm and 12 mm, respectively. The incidence of the canal decreased with age as sinus pneumatization extended into the sphenoid sinus. Only 0.8% of the adult skull on CT had the canal. The canal was not present on the dry adult skulls examination, but SD was found in 4.65%. CONCLUSION SC exists with high incidence in the pediatric group. Sinus pneumatization obliterates the canal in the adult population, leaving a defect in 4.65% of cases, which given the location and related anatomic structures, is unlikely to be a source of CSF leak.

scholarly journals Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

2019 ◽  
Vol 81 (05) ◽  
pp. 553-561
Author(s):  
Gülpembe Bozkurt ◽  
Mario Turri-Zanoni ◽  
Elisa Coden ◽  
Federico Russo ◽  
Hassan Ahmed Elhassan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dry Eye ◽  
Sphenoid Sinus ◽  
Cerebrospinal Fluid Leak ◽  
Significant Morbidity ◽  
Endoscopic Endonasal ◽  
Lateral Recess ◽  
Fluid Leak ◽  
Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

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