CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele

Alzuwayed Abdullah; Algouhi Amani; Al Mahdi Mohammad; Alhedaithy Riyadh

doi:doi:10.11648/j.js.20210904.16

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CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele

Alzuwayed Abdullah, Algouhi Amani, Al Mahdi Mohammad, Alhedaithy Riyadh

Published in Journal of Surgery (Volume 9, Issue 4)

Received: 30 May 2021 Accepted: 19 June 2021 Published: 28 June 2021

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Abstract

A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.

Published in	Journal of Surgery (Volume 9, Issue 4)
DOI	10.11648/j.js.20210904.16
Page(s)	176-179
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Case Report, CSF Leak, COVID-19 Swab, Meningocele

References

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[2]	Department of health 2020, accessed 2 December 2020, https://www.health.gov.au/resources/publications/phln-guidance-on-laboratory-testing-forsars-cov-2-the-virus-that-causes-covid-19.
[3]	Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020 Mar 19; 91 (1): 157-160. doi: 10.23750/abm.v91i1.9397.
[4]	Hanson KE, Caliendo AM, Arias CA, Hayden MK, Englund JA, Lee MJ, Loeb M, Patel R, El Alayli A, Altayar O, Patel P, Falck-Ytter Y, Lavergne V, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing. Infectious Diseases Society of America 2020; Version 2.0.0.
[5]	Centers for Disease Control and Prevention. Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19. Feb. 26, 2021.
[6]	Alberola-Amores FJ, Valdeolivas-Urbelz E, Torregrosa-Ortiz M, Álvarez-Sauco M, Alom-Poveda J. Meningitis due to cerebrospinal fluid leak after nasal swab testing for COVID-19. European Journal of Neurology. 2021 Jan. DOI: 10.1111/ene.14736.
[7]	Rajah, J., & Lee, J. (2021). CSF rhinorrhoea post COVID-19 swab: A case report and review of literature. Journal of Clinical Neuroscience, 86, 6–9. https://doi.org/10.1016/j.jocn.2021.01.003.
[8]	Daele JJM, Goffart Y, Machiels S. Traumatic, iatrogenic, and spontaneous cerebrospinal fluid (CSF) leak: endoscopic repair. B-ENT 2011; 7 (suppl 17): 47–60.
[9]	De Divitiis E, Laws Jr E. The Transnasal versus Transcranial Approach to Lesions of the Anterior Skull Base. World Neurosurg. 2013; 80: 728-731.
[10]	Eljamel MS, Pidgeon CN, Toland J. MRI cisternography and the localization of CSF fistulae. Br J Neurosurg. 1994; 8: 433-7.
[11]	Samuel K, White TG, Black K, Rebeiz T, Weintraub D. Cerebrospinal fluid leak as a complication of intranasal COVID-19 swabbing following remote transsphenoidal surgery. Open J Clin Med Case Rep. 2020; 1694.
[12]	Bialer OY, Rueda MP, Bruce BB, Newman NJ, Biousse V, Saindane AM. Meningoceles in idiopathic intracranial hypertension. AJR AmJ Roentgenol. 2014; 202 (3): 608-613. doi: 10.2214/AJR.13.10874\.

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APA Style

Alzuwayed Abdullah, Algouhi Amani, Al Mahdi Mohammad, Alhedaithy Riyadh. (2021). CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. Journal of Surgery, 9(4), 176-179. https://doi.org/10.11648/j.js.20210904.16

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ACS Style

Alzuwayed Abdullah; Algouhi Amani; Al Mahdi Mohammad; Alhedaithy Riyadh. CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. J. Surg. 2021, 9(4), 176-179. doi: 10.11648/j.js.20210904.16

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AMA Style

Alzuwayed Abdullah, Algouhi Amani, Al Mahdi Mohammad, Alhedaithy Riyadh. CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. J Surg. 2021;9(4):176-179. doi: 10.11648/j.js.20210904.16

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@article{10.11648/j.js.20210904.16,
  author = {Alzuwayed Abdullah and Algouhi Amani and Al Mahdi Mohammad and Alhedaithy Riyadh},
  title = {CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {176-179},
  doi = {10.11648/j.js.20210904.16},
  url = {https://doi.org/10.11648/j.js.20210904.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.16},
  abstract = {A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.},
 year = {2021}
}

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TY  - JOUR
T1  - CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele
AU  - Alzuwayed Abdullah
AU  - Algouhi Amani
AU  - Al Mahdi Mohammad
AU  - Alhedaithy Riyadh
Y1  - 2021/06/28
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.16
DO  - 10.11648/j.js.20210904.16
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 176
EP  - 179
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.16
AB  - A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.
VL  - 9
IS  - 4
ER  -

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Author Information

Alzuwayed Abdullah

Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Algouhi Amani

Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Al Mahdi Mohammad

Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Alhedaithy Riyadh

Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia

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APA Style

Alzuwayed Abdullah, Algouhi Amani, Al Mahdi Mohammad, Alhedaithy Riyadh. (2021). CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. Journal of Surgery, 9(4), 176-179. https://doi.org/10.11648/j.js.20210904.16

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ACS Style

Alzuwayed Abdullah; Algouhi Amani; Al Mahdi Mohammad; Alhedaithy Riyadh. CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. J. Surg. 2021, 9(4), 176-179. doi: 10.11648/j.js.20210904.16

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AMA Style

Alzuwayed Abdullah, Algouhi Amani, Al Mahdi Mohammad, Alhedaithy Riyadh. CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele. J Surg. 2021;9(4):176-179. doi: 10.11648/j.js.20210904.16

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@article{10.11648/j.js.20210904.16,
  author = {Alzuwayed Abdullah and Algouhi Amani and Al Mahdi Mohammad and Alhedaithy Riyadh},
  title = {CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {176-179},
  doi = {10.11648/j.js.20210904.16},
  url = {https://doi.org/10.11648/j.js.20210904.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.16},
  abstract = {A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.},
 year = {2021}
}

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TY  - JOUR
T1  - CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele
AU  - Alzuwayed Abdullah
AU  - Algouhi Amani
AU  - Al Mahdi Mohammad
AU  - Alhedaithy Riyadh
Y1  - 2021/06/28
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.16
DO  - 10.11648/j.js.20210904.16
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 176
EP  - 179
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.16
AB  - A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.
VL  - 9
IS  - 4
ER  -

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