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Abstract
Acquired skull base cerebrospinal fluid (CSF) leaks can result from trauma, tumors, iatrogenic causes, or may be spontaneous. Spontaneous skull base CSF leaks are likely a manifestation of underlying idiopathic intracranial hypertension. The initial assessment of rhinorrhea or otorrhea which is suspected to be due to an acquired skull base CSF leak requires integration of clinical assessment and biochemical confirmation of CSF. Imaging with high-resolution CT is performed to locate osseous defects, while high-resolution T2w MRI may detect CSF traversing the dura and bony skull base. When leaks are multiple or if samples of fluid cannot be obtained for testing, then recourse to invasive cisternography may be necessary.
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Affiliation(s)
- Daniel J Scoffings
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
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Guillem L, García-Roulston K, Cabellos C. Bacterial meningitis related to air travel: Who is at risk? J Travel Med 2021; 28:6325575. [PMID: 34297118 DOI: 10.1093/jtm/taab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Abstract
Changes in aircraft cabin pressure may result in bacterial meningitis in passengers with particular risk factors. The participation of multiple factors stands out, such as barotrauma, ear nose throat bacteria and cerebrospinal fluid leakage. As this is a neglected topic in aviation medicine, a synopsis of cases observed and previously published is presented.
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Affiliation(s)
- Lluïsa Guillem
- Infectious Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Kevin García-Roulston
- Infectious Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Carmen Cabellos
- Infectious Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Catalunya, Spain
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Takahashi CE, Virmani D, Chung DY, Ong C, Cervantes-Arslanian AM. Blunt and Penetrating Severe Traumatic Brain Injury. Neurol Clin 2021; 39:443-469. [PMID: 33896528 DOI: 10.1016/j.ncl.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.
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Affiliation(s)
- Courtney E Takahashi
- Department of Neurology, Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA.
| | - Deepti Virmani
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - David Y Chung
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA; Division of Neurocritical Care, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Neurovascular Research Unit, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Charlene Ong
- Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA
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Kurdyumova NV, Savin IA, Ershova ON, Shifrin MA, Danilov GV, Usachev DY. [Risk factors of nosocomial meningitis in neurological intensive care unit. Results of a five-year prospective study]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:83-91. [PMID: 34951764 DOI: 10.17116/neiro20218506183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Nosocomial meningitis (NM) is a serious complication in neurosurgery. Understanding the risk factors of nosocomial meningitis is important for their prevention. OBJECTIVE To determine the main risk factors of NM in neurological intensive care unit. MATERIAL AND METHODS A prospective study included all patients (n=2140) treated at the neurological intensive care unit for more than 48 hours between October 1, 2010 and October 31, 2015. Cases of nosocomial meningitis were registered. We analyzed risk factors in 2 groups of patients (with and without NM). RESULTS AND DISCUSSION The incidence of NM in neurological intensive care unit was 8.4% (95% CI 6.8-10.0) (n=180). Relative risk of NM under external ventricular drainage was 3.98 (99 cases of NM, p<0.05). Relative risk of NM in patients with CSF leakage (including nasal CSF leakage after transsphenoidal surgery) was 5.2 (49 cases of NM, p<0.05). The incidence of nosocomial meningitis was significantly higher among patients with surgery time ≥8 hours (17.68%, p<0.01). Nosocomial meningitis was also significantly more common after redo surgery (13.07%, p<0.05). Insertion of intracranial pressure sensor was not a significant risk factor of NM. The risk of meningitis was 2.67% if the above-mentioned factors were absent. Extracranial factors are not specific for NM. No significant relationship between certain neurosurgical disease and NM was found. CONCLUSION We found higher risk of NM in ICU patients with the following factors: external ventricular drainage, CSF leakage, redo surgery and surgery time.
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Affiliation(s)
| | - I A Savin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - O N Ershova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M A Shifrin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - G V Danilov
- Burdenko Neurosurgical Center, Moscow, Russia
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Post-Traumatic Meningitis Is a Diagnostic Challenging Time: A Systematic Review Focusing on Clinical and Pathological Features. Int J Mol Sci 2020; 21:ijms21114148. [PMID: 32532024 PMCID: PMC7312088 DOI: 10.3390/ijms21114148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Post-traumatic meningitis is a dreadful condition that presents additional challenges, in terms of both diagnosis and management, when compared with community-acquired cases. Post-traumatic meningitis refers to a meningeal infection causally related to a cranio-cerebral trauma, regardless of temporal proximity. The PICO (participants, intervention, control, and outcomes) question was as follows: "Is there an association between traumatic brain injury and post-traumatic meningitis?" The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. Studies examining post-traumatic meningitis, paying particular attention to victims of traumatic brain injury, were included. Post-traumatic meningitis represents a high mortality disease. Diagnosis may be difficult both because clinical signs are nonspecific and blurred and because of the lack of pathognomonic laboratory markers. Moreover, these markers increase with a rather long latency, thus not allowing a prompt diagnosis, which could improve patients' outcome. Among all the detectable clinical signs, the appearance of cranial cerebrospinal fluid (CSF) leakage (manifesting as rhinorrhea or otorrhea) should always arouse suspicion of meningitis. On one hand, microbiological exams on cerebrospinal fluid (CSF), which represent the gold standard for the diagnosis, require days to get reliable results. On the other hand, radiological exams, especially CT of the brain, could represent an alternative for early diagnosis. An update on these issues is certainly of interest to focus on possible predictors of survival and useful tools for prompt diagnosis.
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Factors associated with posttraumatic meningitis among traumatic head injury patients: a nationwide study in Japan. Eur J Trauma Emerg Surg 2019; 47:251-259. [PMID: 31478074 PMCID: PMC7851005 DOI: 10.1007/s00068-019-01224-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022]
Abstract
Purpose Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. Methods This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. Results Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401–3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506–2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157–2.935]), CSF leakage (AOR 3.328 [95% CI 2.205–5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178–2.314]). Conclusions In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.
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Kuehl R, Büchler A, Widmer AF, Battegay M. Digging Out the Evidence—How Strong Is the IDSA Recommendation Against Antibiotic Prophylaxis in Basilar Skull Fracture and Cerebrospinal Fluid Leakage? Clin Infect Dis 2018; 66:1319-1320. [DOI: 10.1093/cid/cix984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Richard Kuehl
- Division for Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Andrea Büchler
- Division for Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Andreas F Widmer
- Division for Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division for Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
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Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, van de Beek D, Bleck TP, Zunt JR, Tunkel AR. Reply to Kuehl et al. Clin Infect Dis 2018; 66:1320-1321. [DOI: 10.1093/cid/cix985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rodrigo Hasbun
- The University of Texas Health Sciences Center at Houston
| | | | - Karin Byers
- University of Pittsburgh Medical Center, Pennsylvania
| | | | | | | | | | | | - Allan R Tunkel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Adepoju A, Adamo MA. Posttraumatic complications in pediatric skull fracture: dural sinus thrombosis, arterial dissection, and cerebrospinal fluid leakage. J Neurosurg Pediatr 2017; 20:598-603. [PMID: 29027868 DOI: 10.3171/2017.6.peds16702] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Skull fracture is associated with several intracranial injuries. The object of this study was to determine the rate of fracture associated with venous thrombosis, intracranial arterial dissection (ICAD), and cerebrospinal fluid (CSF) leakage in pediatric patients. Further, the authors aimed to highlight the features of pediatric skull fracture that predict poor neurological outcomes. METHOD In this retrospective study, the authors evaluated the records of 258 pediatric patients who had incurred a traumatic skull fracture in the period from 2009 to 2015. All the patients had undergone CT imaging, which was used to characterize the type of skull fracture and other important features, including intracranial hemorrhage. Patients with fracture extending to a dural sinus or proximal to major intracranial vessels had undergone vascular imaging to evaluate for venous thrombosis or arterial dissection. Clinical data were also reviewed for patients who had CSF leakage. RESULTS Two hundred fifty-eight patients had 302 skull fractures, with 11.6% having multiple fractures. Falling was the most common mechanism of injury (52.3%), and the parietal bone was most frequently involved in the fracture (43.4%). Diastatic fracture was associated with increased intracranial hemorrhage (p < 0.05). The rate of venous thrombosis was 0.4%, and the rate of ICAD was also 0.4%. The rate of CSF leakage was 2.3%. Skull base fracture was the only significant risk factor associated with an increased risk of CSF leakage (p < 0.05). There was a significant difference in fracture-related morbidity in patients younger than versus older than 2 years of age. Patients younger than 2 years had fewer intracranial hemorrhages (21.8% vs 38.8%) and fewer neurosurgical interventions (3.0% vs 12.7%) than the patients older than 2 years (p < 0.001). Moreover, skull fracture in the younger group was mostly caused by falling (81.2% vs 33.1%); in the older group, fracture was most often caused by vehicle-related accidents (35.7% vs 4.0%) and being struck by or against an object (19.1% vs 7.9%). Additionally, skull fracture location was analyzed based on the mechanism of injury. Parietal bone fracture was closely associated with falling, and temporal bone fracture was associated with being struck by or against an object (p < 0.05). Frontal bone fracture was more associated with being struck by or against an object and vehicle-related injury (p < 0.05) than with falling. Vehicle-related accidents and being struck by or against an object, as opposed to falling, were associated with increased surgical intervention (13.3% vs 16.2% vs 3.7%, respectively). CONCLUSIONS Pediatric skull fracture usually has a benign outcome in patients who fall and are younger than 2 years of age. Poor prognostic factors include diastasis, an age > 2 years, and fracture caused by vehicle-related accidents or being struck by or against an object. In this series, the rates of venous thrombosis and ICAD were low, and the authors do not advocate vascular imaging unless these disease entities are clinically suspected. Patients with skull base fracture should be closely monitored for CSF leakage.
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Incidence, Predictors, and Outcomes of Ventriculostomy-Associated Infections in Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2017; 24:389-96. [PMID: 26337068 DOI: 10.1007/s12028-015-0199-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of ventriculostomy-associated infections (VAI) on intracerebral hemorrhage (ICH) outcomes has not been clearly established, although prior studies have attempted to address the incidence and predictors of VAI. We aimed to explore VAI characteristics and its effect on ICH outcomes at a population level. METHODS ICH patients requiring ventriculostomy with and without VAI were identified from 2002 to 2011 Nationwide Inpatient Sample using ICD-9 codes. A retrospective cohort study was performed. Demographics, comorbidities, hospital characteristics, inpatient outcomes, and resource utilization measures were compared between the two groups. Pearson's Chi-square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables, respectively. Logistic regression was used to analyze the predictors of VAI. RESULTS We included 34,238 patients in the analysis, of whom 1934 (5.6 %) had VAI. The rate of ventriculostomy utilization in ICH increased from 5.7 % in 2002-2003 to 7.0 % in 2010-2011 (trend p < 0.001) and the rate of VAI also showed a gradual upward trend from 6.1 to 7.0 % across the same interval (trend p < 0.001). The VAI group had significantly higher inpatient mortality (41.2 vs. 36.5 %, p < 0.001) and it remained higher after controlling for baseline demographics, hospital characteristics, comorbidity, and systemic infections (adjusted OR 1.38, 95 % CI 1.22-1.46, p < 0.001). The VAI group had longer length of hospital stay and higher inflation adjusted cost of care. Predictors of VAI included higher age, males, higher Charlson's comorbidity scores, longer length of stay, and presence of systemic infections mainly pneumonia and sepsis. CONCLUSION VAI resulted in higher inpatient mortality, more unfavorable discharge disposition, and higher resource utilization measures in ICH patients. Steps to mitigate VAI may help improve ICH outcomes and decrease hospital costs.
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Kim J, Kim C, Ryu YJ, Lee SJ. Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture. J Korean Neurosurg Soc 2016; 59:310-3. [PMID: 27226867 PMCID: PMC4877558 DOI: 10.3340/jkns.2016.59.3.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/09/2015] [Accepted: 04/17/2015] [Indexed: 11/27/2022] Open
Abstract
Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.
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Affiliation(s)
- Jiha Kim
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Choonghyo Kim
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Joon Ryu
- Department of Pathology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Michael LM, Klimo P. Outcomes Research in Neurosurgery: Do Administrative Databases Hold the Answers? World Neurosurg 2015; 84:1193-5. [DOI: 10.1016/j.wneu.2015.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
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Penetrant injury of the nose with a foreign material. J Craniofac Surg 2014; 24:1853-6. [PMID: 24036798 DOI: 10.1097/scs.0b013e318293f900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Compared to the cerebrospinalfluid (CSF) leak through the nose and ear, the orbital CSF leak is a rare and underreported condition following head trauma. We present the case of a 49-year-old woman with oedematous eyelid swelling and ecchymosis after a seemingly trivial fall onto the right orbit. Apart from the above, she was clinically unremarkable. The CT scan revealed a minimally displaced fracture of the orbital roof with no emphysema or intracranial bleeding. The fractured orbital roof in combination with the oedematous eyelid swelling raised the suspicion for orbital CSF leak. The MRI of the neurocranium demonstrated a small-sized CSF fistula extending from the anterior cranial fossa to the right orbit. The patient was treated conservatively and the lid swelling resolved completely after 5 days. Although rare, orbital CSF leak needs to be included in the differential diagnosis of periorbital swelling following orbital trauma.
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Affiliation(s)
- Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
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Goldschmidt E, Hem S, Ajler P, Ielpi M, Loresi M, Giunta D, Carrizo A, Yampolsky C, Argibay P. A new model for dura mater healing: human dural fibroblast culture. Neurol Res 2013; 35:300-7. [DOI: 10.1179/1743132812y.0000000136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Ezequiel Goldschmidt
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Santiago Hem
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Pablo Ajler
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Marcelo Ielpi
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Monica Loresi
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Diego Giunta
- Clinical Research Division Clinical Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Carrizo
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Claudio Yampolsky
- Neurosurgery Service Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
| | - Pablo Argibay
- Institute of Basic Science and Experimental Medicine (ICBME) Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
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Zappella N, Barrelet A, Pangon B, Laurent V, Bruneel F. [Group A streptococcal meningitis: Streptococcus pneumoniae is not the only one to seep into the CSF fluid leak!]. ACTA ACUST UNITED AC 2013; 32:811-3. [PMID: 24161291 DOI: 10.1016/j.annfar.2013.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
We reported a case of group A streptococcal meningitis in a patient with a CSF fluid leak. This case underlined several relevant points: (i) an unfrequent cause of bacterial meningitis; (ii) the main diagnosis to evoke when the direct examination of CSF shows Gram+ cocci with a negative pneumococcal antigen; (iii) that bacteria other than Streptococcus pneumoniae are possible in front of a meningitis associated with a CSF fluif leak.
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Affiliation(s)
- N Zappella
- Service de réanimation médico-chirurgicale, hôpital Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
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