Cerebrospinal fluid rhinorrhea 41 years after injury

Community-acquired Serratia marcescens meningitis

Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.

Post-traumatic cerebrospinal fluid rhinorrhoea: modern high-definition computed tomography is all that is required for the effective demonstration of the site of leakage

Accurate definition of the site of cerebrospinal fluid (CSF) leakage is essential for the successful surgical management of CSF rhinorrhoea and associated recurrent meningitis. Previous attempts to image the sites of leakage, including conventional computed tomography (CT) and cisternography using either iodine-containing contrast media or radionuclides, have given disappointing results. A dedicated high-resolution computed tomographic (CT) technique combining fine slices in two planes with a bone algorithm for data manipulation is described and the results in 15 consecutive patients are recorded. This technique promises to render all other diagnostic methods obsolete.

Cerebrospinal fluid rhinorrhea and unilateral nasal polyposis: a case report

We report a case of cerebrospinal fluid (CSF) rhinorrhea and unilateral polyposis in a 53-year-old woman. The clinical features, tomograms, and CT scan with Metrizamide infusion are examined. The analysis of this case evidences that: 1) A CSF can occur also after a long time (3 years) following a head injury; 2) CT cisternography with Metrizamide can demonstrate a leakage, but not always the fluid egress from the intracranial cavity; and 3) A CSF rhinorrhea may be the primary cause and not an occasional association or complication of a reactive phlogistic nasal disease.