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Rare brain fluid leak in woman’s nose linked to COVID-19 test detailed in case study

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This case study redefines picking someone’s brain.

A woman’s coronavirus test went horribly south after she inexplicably began leaking cerebrospinal fluid (CSF) from her nose, according to a case report.

“To our knowledge, this is the first report of an iatrogenic CSF leak after a nasal swab for COVID-19,” read the case study published Thursday in the journal JAMA Otolaryngology – Head & Neck Surgery.

The spine-tingling situation began when the unnamed 40-something patient received a mandatory COVID-19 screening before an elective hernia operation. The test was administered via a nasal swab — a screening method recommended by the US’ Centers for Disease Control and Prevention (CDC).

Shortly thereafter, she began to experience a headache, neck stiffness, photosensitivity, vomiting and a “metallic taste” in her mouth.

Realizing something was awry, she reported to the hospital, where CT scans revealed a 1.8-centimeter pouch of CSF jutting down into the sinus cavity between a fissure in the bone. Known as an encephalocele, the condition was the result of her skull bones not closing completely, leaving a crack where CSF and brain tissue can accumulate into a sac-like formation, according to Children’s Wisconsin health system.



Images from the case report.
Images from the case report.JAMA

Doctors speculate that the nose swab had ruptured the pouch, causing the brain-shielding spinal liquid to leak out, reported CTV News. In turn, the patient had experienced a change in cerebral equilibrium referred to as spontaneous intracranial hypotension. The patient also had high pressure in the brain due to the spinal fluid pouch.

An accidental spinal tap might seem like gross malpractice. However, analysis of a 2017 CT scan revealed that the woman’s encephalocele was misidentified as nasal inflammation.

Read More:  Adamawa discharges eight COVID-19 patients

Armed with this knowledge, doctors were able to fill in the problematic gap in the bone using a soft tissue skin graft.

Nonetheless, the patient’s case highlights the “need to properly train clinicians and even the general public” about swab screening, per the report, as governments across the globe roll out both DIY and automated swabbing measures to help shield health-care workers from contracting the coronavirus.

In order to avoid another inadvertent brain drain, the study proposed alternative screening procedures for patients suffering from sinus problems or skull-related ailments.

Images from the case report.
Images from the case report.JAMA

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