Resident’s brain fluid was leaking through his nose

By Divi S.

Rare endoscopy surgery stops leakage

DUBAI 17 March 2019: A UAE resident was brought into hospital with the fluid – normally found surrounding the brain and spinal cord – leaking through his nose.

Dr Saied Alhabash, Consultant ENT Surgeon at Medcare Multispecialty Hospital Sharjah performed lifesaving endoscopic surgery to remove a small sac located in the nasal sinus of the patient that was causing the leakage.

The patient showing typical symptoms indicating pneumonia including high fever, severe cough and chest pain, had been given standard treatment of antibiotics – but saw no improvement. The patient then started complaining of a strange clear fluid leaking from the nose.

This raised suspicion of leakage of the fluid normally found around the brain, also known as cerebrospinal fluid (CSF). A series of tests were run including assessment for the beta transferrin protein found only in brain fluid, as well as a CT scan and an MRI scan of the head and sinuses to find the location of the leak.

Potential Meningitis

Doctors found a small meningocele sac in the nose, which was causing increased pressure around the brain and leakage of brain fluid through the nose, also known as CSF rhinorrhea. Dr Alhabash said, “CSF rhinorrhea carries the risk of developing into meningitis, so it was vital for the patient to seek treatment from a doctor as soon as possible after symptoms were detected”. Dr Alhabash performed endoscopic surgery to successfully remove the meningocele and close the gaps to stop all leakage.

Rare Case

These types of cases are rarely seen in the UAE, but the uniqueness in this case was that the patient came with symptoms of pneumonia and the CSF leak was recognised later at the final stage of pneumonia treatment. With this patient, Medcare surgeons used the latest technology to provide minimally-invasive, lifesaving treatment. When asked about prognosis of the condition, Dr Alhabash said “surgery can treat these conditions almost completely, but any residual intracranial hypertension should then be followed up by a neurologist”.

The vast majority of CSF rhinorrhea cases usually occur after a major accident or when the bones of the face and skull experience major trauma. Comparatively, a small proportion of patients develop the condition spontaneously due to meningoceles in the nose, as was seen in this case. These spontaneous cases are usually associated with obesity and high blood pressure. Most leaks resolve on their own if traumatic, but surgery may be needed if leakage persists and especially in cases where the cause is spontaneous.

Dubai Gazette