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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(03): e239-e245
DOI: 10.1055/s-0043-1774742
Case Report

Nasal Cerebrospinal Leaks in the Milieu of COVID-19 Pandemic

Vazamentos nasais cerebroespinhais no meio da pandemia de COVID-19
Oleg I. Sharipov
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Nadeghda A. Chenikova
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Ashraf Abdali
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
2   Department of Neurological Diseases and Neurosurgery, People's Friendship University of Russia (RUDN University), Mikluko-Maklaya St, Moscow, Russian Federation
,
Vishal Chavda
3   Division of Anaesthesia, Sardar Women's Hospital, Ahmedabad, Gujarat, India
,
Elizaveta B. Shelesko
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Maksim A. Kutin
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Olga N. Ershova
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Pavel L. Kalinin
1   Department of Eight, Skull Base, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
,
Bipin Chaurasia 
4   Department of Neurosurgery, Neurosurgery Clinic Birgunj, Birgunj, Nepal
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Funding Support and Sponsorship This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background The unintentional ingestion of oropharyngeal or gastric contents into the respiratory tract is known as aspiration. Rhinorrhea can cause aspiration pneumonia (cerebrospinal fluid leakage).

Objective There are only a few reports in the literature about pneumonia as a complication of rhinorrhea. There are no reports on how to handle such cases if they present to the clinic at the peak of COVID-19 disease and distinguish between these two conditions.

Methods We reviewed the literature and retrospectively analyzed the clinical information and treatment protocols used to treat the two clinical cases.

Results By screening the COVID-19 PCR and antibodies more than twice, surgery was postponed for 10–14 days in both cases to rule out COVID-19-induced pneumonia. Chest CT scans still revealed ground glass opacities. In both cases, the skull base defect was repaired. In both cases, radiological signs of rhinorrhea-induced pneumonia had completely resolved at the 24- and 30-day follow-ups.

Conclusion CSF aspiration causes radiological changes in the lungs in rhinnorhea. This is a short-term local decrease in lung tissue airness (partial filling of alveoli with fluids), which is visible radiographically (ground-glass opacities). To rule out COVID-19 infection, surgery should be postponed for 10–14 days, and PCR and antibodies (IgG,IgM) should be performed at least twice. If the COVID-19 screening test is negative, repair surgery can be scheduled.

Resumo

Introdução A ingestão não intencional de conteúdo orofaríngeo ou gástrico no trato respiratório é conhecida como aspiração. A rinorréia pode causar pneumonia por aspiração (vazamento de líquido cefalorraquidiano).

Objetivo Existem poucos relatos na literatura sobre pneumonia como complicação da rinorréia. Não há relatos sobre como lidar com esses casos se eles se apresentarem à clínica no pico da doença COVID-19 e distinguirem entre essas duas condições.

Métodos Revisamos a literatura e analisamos retrospectivamente as informações clínicas e os protocolos de tratamento utilizados para tratar os dois casos clínicos.

Resultados Ao rastrear a PCR e os anticorpos da COVID-19 mais de duas vezes, a cirurgia foi adiada por 10 a 14 dias em ambos os casos para descartar pneumonia induzida pela COVID-19. A tomografia computadorizada de tórax ainda revelou opacidades em vidro fosco. Em ambos os casos, o defeito na base do crânio foi reparado. Em ambos os casos, os sinais radiológicos de pneumonia induzida por rinorréia foram completamente resolvidos nos acompanhamentos de 24 e 30 dias.

Conclusão A aspiração do LCR causa alterações radiológicas nos pulmões na rinorreia. Esta é uma diminuição local de curto prazo na leveza do tecido pulmonar (preenchimento parcial dos alvéolos com fluidos), que é visível radiograficamente (opacidades em vidro fosco). Para descartar infecção por COVID-19, a cirurgia deve ser adiada por 10 a 14 dias e a PCR e anticorpos (IgG, IgM) devem ser realizados pelo menos duas vezes. Se o teste de rastreio da COVID-19 for negativo, pode ser agendada uma cirurgia reparadora.

Keywords

CSF liquor rhea - COVID-19 - aspiration - pneumonia - skull base repair surgery

Palavras-chave

Ema licorosa do LCR - COVID 19 - aspiração - pneumonia - cirurgia de reparo da base do crânio

Consent for Publication

Proper informed and written consent in local understandable language was taken from the patient regarding the publication of the same cases.


Ethics Approval

There is no ethics issue in this paper.


Data Availability Statement

The data will be available from address of correspondence on reasonable request.




Publikationsverlauf

Eingereicht: 09. August 2022

Angenommen: 07. März 2023

Artikel online veröffentlicht:
29. September 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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