ro13-9904 and Cerebrospinal-Fluid-Rhinorrhea

We present a case report of a patient with pneumocranium secondary to halo vest pin penetration and a review of literature. The objectives of this study are to report a rare complication of halo vest pin insertion and to discuss methods of prevention of this complication. Halo vest orthosis is a commonly used and well-tolerated upper cervical spinal stabilizing device. Reports of complications related to pin penetration is rare and from our review, there has been no reports of pneumocranium occurring from insertion of pins following standard anatomical landmarks. A 57-year-old male sustained a type 1 traumatic spondylolisthesis of C2/C3 following a motor vehicle accident. During application of the halo vest, penetration of the left anterior pin through the abnormally enlarged frontal sinus occurred. The patient developed headache, vomiting and CSF rhinorrhoea over his left nostril. He was treated with intravenous Ceftriaxone for 1 week. This resulted in resolution of his symptoms as well as the pneumocranium. In conclusion, complications of halo vest pin penetration are rare and need immediate recognition. Despite the use of anatomical landmarks, pin penetration is still possible due to aberrant anatomy. All patients should have a skull X-ray with a radio-opaque marker done prior to placement of the halo vest pins and halo vest pins have to be inserted by experienced personnel to enable early detection of pin penetration.

Topics: Accidents, Traffic; Anti-Bacterial Agents; Bone Nails; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Cervical Vertebrae; Frontal Sinus; Humans; Male; Middle Aged; Spondylolisthesis; Traction; Treatment Outcome

Non-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a rare condition. We describe a case of a 62-year-old woman with pneumococcal bacterial meningitis who later was found to have CSF rhinorrhoea secondary to an eroding skull base tumour, which was proven to be pituitary macroadenoma on biopsy. She recovered well from meningitis without any neurological sequelae and underwent trans-sphenoidal surgery for tumour removal as well as dural repair.

Topics: Adenoma; Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Meningitis, Bacterial; Middle Aged; Pituitary Neoplasms; Skull Base Neoplasms; Tomography, X-Ray Computed

Iatrogenic cerebrospinal fluid (CSF) rhinorrhea in a bilateral frontal decompressive craniectomy patient triggered by strenuous sport is rare. To the best of our knowledge, no similar case has yet been reported.. Herein, we report a case of CSF rhinorrhea in a 37-year-old man. He had previously suffered a traumatic brain injury in a traffic accident, and a subsequent bilateral frontal decompressive craniectomy operation was performed. Based on the frontal skull defect peculiarity, strenuous exercise may have caused drastic CSF pressure waves to tear the dura mater of the anterior skull base, resulting in CSF rhinorrhea.. The thin-slice computerized tomography (CT) images revealed a frontal skull defect and the open frontal sinus. In addition, in the opened frontal sinus, low-density liquid-filled areas were visible.. During surgery, the torn dura was carefully repaired, and the frontal sinus was filled with temporal muscle, fascia, and fibrin glue. A simultaneous cranioplasty was performed.. The patient was followed-up postoperatively for 12 months to date without rhinorrhea recurrence. Recovery was uneventful.. Patients with skull defects should avoid strenuous sports, and cranioplasty should be performed as early as possible in order to decrease the likelihood of a dural tear and prevent the occurrence of CSF leakage. After cranioplasty, the skull should be restored to a closed state to reduce the damaging effects of CSF waves during movement. It is important to maintain normal intracranial pressure to reduce the recurrence rate of CSF rhinorrhea.

Topics: Accidents, Traffic; Adult; Anti-Bacterial Agents; Brain Injuries, Traumatic; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Decompressive Craniectomy; Dura Mater; Exercise; Frontal Sinus; Humans; Male; Meningitis, Bacterial; Pneumococcal Infections; Postoperative Complications; Skull Base

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Community-Acquired Infections; Dexamethasone; DNA, Bacterial; Drug Therapy, Combination; Female; Fistula; Humans; Magnetic Resonance Imaging; Meningitis; Middle Aged; Respiratory Tract Fistula; Ribotyping; Sphenoid Sinusitis; Streptococcal Infections; Streptococcus; Subarachnoid Space; Tomography, X-Ray Computed

Bilateral, spontaneous cerebrospinal fluid rhinorrhoea is extremely rare, with only one previous case report (this patient developed contralateral cerebrospinal fluid leakage four years after successful endoscopic repair). We present the first English-language report of simultaneous, bilateral, spontaneous cerebrospinal fluid rhinorrhoea.. To recommend a simple alternative endoscopic technique for simultaneous closure of bilateral, spontaneous cerebrospinal fluid rhinorrhoea.. A 47-year-old woman presented with recent onset of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, a recent history suggestive of meningitis, and a past history of pneumococcal meningitis. Bony defects on both sides of the cribriform plate were closed endoscopically in the same anaesthetic session, via a uninasal, trans-septal approach, enabling both leakage sites to be sealed simultaneously.. In cases of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, uninasal, trans-septal endoscopic repair is a simple and effective technique for simultaneous closure of cerebrospinal fluid leakage.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Endoscopy; Ethmoid Bone; Female; Fistula; Humans; Magnetic Resonance Imaging; Meningitis, Bacterial; Middle Aged; Minimally Invasive Surgical Procedures; Nasal Cavity; Nasal Surgical Procedures; Postoperative Care; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome

Two uncommon presentations of Arcanobacterium Haemolyticum infection (sinusitis and pharyngitis) are described, emphasizing the poor response to commonly used antibiotics and the possibility of serious local and systemic complications. The difficulties still encountered in the clinical diagnosis are underlined, since this organism could easily pass unrecognized in bacteriological cultures.

Topics: Actinomycetales; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Betamethasone; Ceftriaxone; Cerebrospinal Fluid Rhinorrhea; Female; Humans; Injections, Intramuscular; Male; Tomography, X-Ray Computed