Korean J Intern Med.  2012 Sep;27(3):350-352. 10.3904/kjim.2012.27.3.350.

Spontaneous Cerebrospinal Fluid Rhinorrhea with Pneumocephalus: An Unusual Manifestation of Nasal Tuberculosis

• Baig WW
• Nagaraja M
• Varma M

• KMID: 1776529
• DOI: http://doi.org/10.3904/kjim.2012.27.3.350

Abstract

An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.

Keyword

Cerebrospinal fluid rhinorrhea; Pneumocephalus; Tuberculosis

MeSH Terms

Antitubercular Agents/therapeutic use
Biopsy
Cerebrospinal Fluid Rhinorrhea/diagnosis/*etiology/therapy
Endoscopy
Female
Humans
Middle Aged
Nose Diseases/*complications/diagnosis/microbiology/therapy
Otorhinolaryngologic Surgical Procedures
Pneumocephalus/diagnosis/*etiology/therapy
Tomography, X-Ray Computed
Treatment Outcome
Tuberculosis/*complications/diagnosis/microbiology/therapy