Delayed unilateral watery nasal discharge after radical ethmoidectomy for nasal polyposis: Cerebrospinal fluid rhinorrhea?

Pallister-Hall syndrome (PHS) is extremely rare autosomal dominant disorder with typical clinical features such as presence of polydactyly, hypothalamic hamartoma, bifid epiglottis, anal, renal, genitourinary and pulmonary abnormalities, mainly located in the midline of the body. Spontaneous cerebrospinal fluid (CSF) rhinorrhea is also a rare condition, and it is used to describe nasal discharge of CSF unrelated to previous trauma, localized tumour, surgery, or previous radiation therapy. The exact cause is not yet fully understood. We report a case of adult female patient previously diagnosed with PHS and late onset of spontaneous nasal liquorrhea, due to defect in the anterior skull base. Although it can be incidental finding, we believe that described defect in the body midline can be another presentation of congenital craniofacial abnormality which are common in PHS.

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Untreated Non-Functioning Pituitary Adenoma Causing Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.11543 ◽

2020 ◽

Vol 103 (9) ◽

pp. 960-963

Keyword(s):

Cerebrospinal Fluid ◽

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Case Reports ◽

Medical Attention ◽

Nasal Discharge ◽

Csf Rhinorrhea ◽

Cerebrospinal Fluid Rhinorrhea ◽

Presenting Symptoms ◽

Csf Leakage

Cerebrospinal fluid (CSF) leakage is common with traumatic brain injury or after transsphenoidal surgery (TSS). In contrast, spontaneous rhinorrhea caused by pituitary adenoma (PA) without prior treatment is rather unusual. Moreover, cases of non-functioning PA (NFPA) who seek medical attention without visual or hormonal symptoms but with watery nasal discharge, mistaken for rhinitis, and misled to delayed diagnosis, are extremely rare. The authors presented a case of spontaneous CSF rhinorrhea, confirmed by clinical, laboratory, and radiographic studies, caused by NFPA. Endoscopic TSS came across a typical PA, and subsequently, the sellar defect was successfully repaired. Pathological diagnosis of NFPA was established. The patient had an uncomplicated postoperative course and complete resolution of her presenting symptoms. A short review of prior case reports is also provided. Keywords: Spontaneous cerebrospinal fluid rhinorrhea, Pituitary adenoma, Non-functioning, Endoscopic transsphenoidal surgery

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Cerebrospinal Fluid Rhinorrhea Post COVID-19 Nasopharyngeal Swab: a Case Report

10.21203/rs.3.rs-235358/v1 ◽

2021 ◽

Author(s):

Sabrina Berdouk ◽

Suhailah AlHefeiti

Keyword(s):

Cerebrospinal Fluid ◽

Cleft Lip ◽

Surgical Repair ◽

Alternative Methods ◽

Csf Leak ◽

Nasopharyngeal Swab ◽

Nasal Discharge ◽

Csf Rhinorrhea ◽

Cerebrospinal Fluid Rhinorrhea ◽

Life Threatening

Abstract Background: Cerebrospinal fluid rhinorrhea is a potentially life threatening condition and it is a rare emergency presentation. Most cases has been related to head trauma. However, CSF leak post COVID swab has been rarely reported.Case presentation: We report a 10 year old Emirati male, who presented to emergency department complaining of unilateral clear watery nasal discharge for 14 days, the discharge started after COVID-19 nasopharyngeal swab. The patient is a known case of 3MC syndrome and he underwent surgical repair for cleft lip and cleft palate. From the history and physical examination CSF rhinorrhea was highly suspected and nasal endoscopy confirmed the diagnosis of cribriform defect on the left side. The patient underwent surgical repair and his symptoms resolved after the surgery.Conclusion: We can conclude that COVID-19 nasopharyngeal swab has potential life threatening complications and one should consider the contraindications and the alternative methods available to detect COVID-19 to minimize the potential risks.

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