Differentiation between CSF Otorrhea and Rhinorrhea in an Obscure Case of Recurrent Meningitis

Document Type: Case Report

Authors

1 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Anesthesiology,Ghaem Hospital,Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad,Iran.

3 Department of Otorhinolaryngology, Ghaem Hospital,Faculty of Medicine,Mashhad University of Medical Sciences, Mashhad,Iran.

Abstract

Introduction:
Leakage of cerebrospinal fluid in the skull base may be accompanied with recurrent meningitis. The site of leakage may either be anterior (in the nose and paranasal sinuses) or posterior (in the temporal bone). Various imaging techniques can be used to precisely locate the point of leakage but despite all the advances in imaging techniques there are still some rare cases in which the surgeon can’t be sure on the management approach before the beginning of surgery.
 
Case Report:
In this article we present one of these cases; we used intrathecal fluorescein to locate the source of the leak and made the final decision on the operating table.
 
Conclusion:
Intrathecal fluorescein is helpful in locating the leakage in the ear or the nose in ambiguous cases.

Keywords


1. Oliaei S, Djalilian H. Management of Spontaneous CSF Leaks of Temporal Bone. Otolaryngology - Head and Neck Surgery. [doi: DOI: 10.1016/j. otohns. 2010.06.167]. 2010;143(2, Supplement 2):P98-P.

2. Felisati G, Bianchi A, Lozza P, Portaleone S. Italian multicentre study on intrathecal fluorescein for craniosinusal fistulae. Acta Otorhinolaryngol Ital 2008; 28(4):159-63.

3. Markou K, Goudakos J, Franco-Vidal V, Vergnolles V, Vignes J-R, Darrouzet V. Spontaneous osteodural defects of the temporal bone: diagnosis and management of 12 cases. American Journal of Otolaryngology. [doi: DOI: 10.1016/j. amjoto. 2009. 12.003]. In Press, Corrected Proof.

4. Clifton NJ, Flook E, Pau H. Spontaneous transtemporal CSF otorrhoea. A diagnostic and treatment challenge to the otolaryngologist. Otorhinolaryngologist 2008;2(2):68-71.

5. Gacek R. Arachnoid granulation cerebrospinal fluid otorrhea. The Annals of otology, rhinology, and laryngology1990;99(11):854.

6. Honda N, Okouchi Y, Sato H, Sanuki T, Hato N, Yanagihara N, et al. Bilateral spontaneous cerebrospinal fluid otorrhea. American Journal of Otolaryngology 2004;25(1):68-72.

7. Jackler R. Congenital Malformations of the Inner Ear. In: Flint PW HB, Lund VJ, Niparko JK editor. Cummings Otolaryngology-Head and Neck Surgery. fifth ed: Mosby Inc; 2010. p. 2735-7.

8. Ehmer Jr D, Booth T, Kutz Jr J, Roland P. Radiographic diagnosis of trans-stapedial cerebro-spinal fluid fistula. Otolaryngology-Head and Neck Surgery 2010; 142(5): 694-8.

9. Rupa V, Job A, Rajshekhar V. Adult onset spontaneous CSF otorrhea with oval window fistula and recurrent meningitis:MRI findings. Otolaryngol Head Neck Surg 2001; 124(3): 344-6.

10. Zarandy M, Rajati M, Khorsandi M. Recurrent meningitis due to spontaneous cerebrospinal fluid otorrhea in adults. Mediterr J Otol 2007; 3(2):2.

11. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH. Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 2007; 61(3):161-5; discussion 5-6.
12.
Anari S, Waldron M, Carrie S. Delayed absence seizure: a complication of intrathecal fluorescein injection. A case report and literature review. Auris Nasus Larynx 2007;34(4):515-8.

13. Tabaee A, Placantonakis DG, Schwartz TH, Anand VK. Intrathecal fluorescein in endoscopic skull base surgery. Otolaryngol Head Neck Surg 2007;137(2):316-20.

14. Clarós P, Guirado C, Clarós A, Clarós Jr A, Clavería A, Wienberg P. Association of spontaneous anterior fossa CSF rhinorrhea and congenital perilymphatic fistula in a patient with recurrent meningitis. International Journal of Pediatric Otorhinolaryngology 1993;27(1):65-71.

15. Tyagi I, Syal R, Goyal A. Cerebrospinal fluid otorhinorrhoea due to inner-ear malformations: Clinical presentation and new perspectives in management. Journal of Laryngology and Otology 2005;119(9):714-8.