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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1467-1468

CSF Leak Following Nasal Swab Testing For COVID-19


Department of Neurosurgery and Otolaryngology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India

Date of Submission27-Nov-2020
Date of Decision21-Dec-2020
Date of Acceptance24-Dec-2020
Date of Web Publication30-Oct-2021

Correspondence Address:
Arun Sadashiva
Department of Neurosurgery and Otolaryngology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329562

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How to cite this article:
Sadashiva A, Panji N, Shivappa L. CSF Leak Following Nasal Swab Testing For COVID-19. Neurol India 2021;69:1467-8

How to cite this URL:
Sadashiva A, Panji N, Shivappa L. CSF Leak Following Nasal Swab Testing For COVID-19. Neurol India [serial online] 2021 [cited 2021 Dec 4];69:1467-8. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1467/329562




Sir,

Year 2020 will be marked in the history of mankind by the havoc caused by coronavirus disease-2019 (COVID-19) pandemic. The COVID-19 infection has posed new challenges to our forgotten public health care system across the world. The essence of diagnosis of COVID-19 infection is the detection of virus by RT-PCR collected through nasopharyngeal swab (NPS). CSF rhinorrhea following NPS is one of the dreaded complication and our case is the first to be reported with no preexisting skull base defect.

A 48-year-old man presented with complaints of a watery nasal discharge from the right side of nostril since one month duration following NPS test for COVID-19. Patient had no past history of watery discharge from nose/trauma/nasal surgeries. Local examination revealed a watery discharge from right nostril, more so on bending down.

MR cisternography (Heavily T2-weighted coronal MR images) [as shown in [Figure 1]] was done, which showed a brain herniating in the lateral wall of right sphenoid sinus. CSF noted in the sphenoid sinus on the right side. CT PNS [as shown in [Figure 2]] showed bony defect in the lateral wall of sphenoid sinus.
Figure 1: MRI Brain (A sagittal, B coronal, C axial, D plane orientation) showing herniating brain from the lateral wall of the sphenoid sinus. The sphenoid sinus filled with CSF noted

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Figure 2: CT Brain (A sagittal, B coronal, C axial, D plane orientation) showing defect noted in the right lateral wall of sphenoid sinus

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Patient under GA was taken up endoscopic repair of the defect. Brain noted herniating from the lateral recess of the sphenoid sinus using 30-degree endoscope. [[Figure 3] showing endoscopic image] Repair with multilayered packing done using surgical/gelfoam/muscle/fibrin glue. Post-operative stay was uneventful.
Figure 3: Intraoperative photo showing brain herniating (thick arrow) through the lateral aspect of sphenoid sinus. Fluorescein stained CSF (long arrow) noted in the sphenoid sinus. (Photo taken using 30 degree endoscope

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CSF rhinorrhea is the serious complication of nasopharyngeal swab test. Till now only one case has been reported of CSF rhinorrhea following nasopharyngeal swab test. The patient was a known case of idiopathic intracranial hypertension with encephalocele previously and had undergone nasal polyp surgery 20 yrs back. Following the leak patient underwent reduction of the encephalocele with repair of the defect in fovea ethmoidalis.[1]

Our case patient had no previous history of surgery/trauma and hence is the first case reported in the literature with no preexisting defect.

COVID-19 is a threat to human race and fight against this virus is the need of the hour. Leakage of brain water after swab collection is night mare for the people and may lead to rejection of the screening test. Even the health care worker will be demoralized following such instances.

Self-collection of saliva as a tool instead of nasopharyngeal swabs have shown promising results may replace traditional nasopharyngeal swab in future.[2],[3],[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sullivan CB, Schwalje AT, Jensen M, Li L, Dlouhy BJ, Greenlee JD, et al. Cerebrospinal fluid leak after nasal swab testing for Coronavirus disease 2019. JAMA Otolaryngol Head Neck Surg JAMA Otolaryngol Head Neck Surg 2020;146:1179-81.  Back to cited text no. 1
    
2.
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi AE, Nagy AK, et al. Saliva as a candidate for COVID-19 diagnostic testing: A meta-analysis. Front Med (Lausanne) 2020;7:465.  Back to cited text no. 2
    
3.
Baghizadeh Fini M. Oral saliva and COVID-19. Oral Oncol 2020;108:104821.  Back to cited text no. 3
    
4.
Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, et al. Saliva or nasopharyngeal swab specimens for detection of SARS-CoV-2. N Engl J Med 2020;383:1283-6.  Back to cited text no. 4
    


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