Chronic subdural haematoma associated with nontraumatic CSF rhinorrhea: a management challenge

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
Santosh Isaac PoonnoosePranatartiharan Ramachandran

Abstract

We report an unusual case of chronic subdural haematoma (CSH) associated with cerebrospinal fluid (CSF) rhinorrhoea emphasizing the importance of managing both conditions simultaneously. A 59- year-old man presented with watery discharge from the right nostril, of 2 months duration. MRI of the brain showed a CSH in the left fronto-parietal region with significant mass effect. There was an arachnoidocoele with a defect in the planum sphenoidale. He first underwent a burr hole evacuation of the CSH following which the CSF rhinorrhea did not subside, even with bed rest. Transnasal endoscopic closure of the CSF dural fistula was done. On the first post-operative day, he was disoriented and a CT scan showed a recollection of the subdural haematoma that required repeat evacuation. The patient was asymptomatic at discharge. To our knowledge this is the first reported case of CSF rhinorrhoea associated with CSH. Simultaneous closure of the CSF dural fistula at the time of evacuation of a coexisting CSH would be the optimal management.

References

Jan 1, 1997·Acta neurochirurgica·C SmelyR Scheremet
Aug 28, 2002·Archives of Internal Medicine·Donald J Gaucher, Jose A Perez
Oct 18, 2002·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·A T C J van EckW Börm

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Citations

Mar 5, 2011·Clinical Neurology and Neurosurgery·I DallanP Castelnuovo
Oct 4, 2016·Asian Journal of Neurosurgery·Yad R YadavJitin Bajaj

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