Case Report: Delayed Onset Cerebrospinal Fluid Rhinorrhea Following Traumatic Head Injury

Abstract

Introduction: CSF leak rhinorrhea is one of the common early post-traumatic craniofacial complications. Conservative treatment is the first choice in the first few weeks of the trauma. A multidisciplinary team, including a neurosurgeon, an otolaryngologist, a craniofacial surgeon, and a radiologist, treats complicated craniocerebral injuries with persistent pneumocephalus. Late post-traumatic nasal CSF leakage is not common and may present with an intracranial complication such as meningitis or meningoencephalitis.

Clinical presentation: It concerns a 34-year old man who was admitted to the Clinic for Infectious Diseases with bacterial meningitis with isolated Streptococcus pneumoniae in the CSF examination. From the patient’s medical history, we understand that he had a watery discharge from the left nose. He was treated on an outpatient basis for allergic rhinitis with a local corticosteroid medication. Eight years ago, he had a motor vehicle accident with severe craniocerebral trauma. After successfully recovering from the intracranial infection, the patient underwent a biochemical analysis of nasal secretion. The beta-2 transferrin analysis was positive. Computed tomography and magnetic resonance imaging were performed. Endonasal endoscopic duraplasty was performed with the application of fluorescein 10% intrathecally. The rhinobase defect was successfully repaired.

Conclusion: Delayed CSF rhinorrhea poses significant diagnostic and therapeutic challenges. Clinicians should maintain a high index of suspicion in patients with unilateral clear nasal discharge and a history of cranial trauma, regardless of the time elapsed since the initial injury. Early diagnosis and surgical intervention are crucial to prevent potentially life-threatening complications.