title: Spontaneous cerebrospinal fluid rhinorrhea with pneumocephalus: an unusual manifestation of nasal tuberculosis.
abstract: An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.
authors.affiliation: Department of Medicine, Manipal University Kasturba Medical College, Karnataka, India. drwaqaswahid@gmail.com
authors.forename: Waqas Wahid
authors.initials: WW
authors.lastname: Baig
authors.forename: Mudugundur Vishwareshaya
authors.initials: MV
authors.lastname: Nagaraja
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Varma
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009668:Nose Diseases / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D013517:Otorhinolaryngologic Surgical Procedures; D011007:Pneumocephalus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy
chemical_list: D000995:Antitubercular Agents