cerebrospinal fluid leak
Introduction
Introduction to cerebrospinal fluid leakage The cerebrospinal fluid cavity communicates with the extracranial cavity, and the cerebrospinal fluid leakage is called cerebrospinal fluid leakage. The continuous loss of cerebrospinal fluid causes headaches, and most of them use medical treatment. Those who have leaked for more than 1 month can be treated with surgery. The main symptom is the phenomenon that the ear and nose flow out of the clear liquid after the traumatic brain injury. Cerebrospinal fluid leakage can be classified according to the cause: traumatic, accidental or iatrogenic and spontaneous. Among them, traumaticity is dominant, and spontaneousness is rare. basic knowledge The proportion of illness: 0.097% Susceptible people: no specific population Mode of infection: non-infectious Complications: disturbance of consciousness, headache, cerebral palsy
Cause
Cerebrospinal fluid leakage
Traumatic bone defect (35%):
The cerebrospinal fluid flows into the nasal cavity through the congenital or traumatic bone defect, rupture or thinning of the anterior cranial fossa, the middle cranial fossa or other parts, which is called cerebrospinal fluid rhinorrhea. In various cerebrospinal fluid rhinorrhea, trauma is most common. Cerebrospinal fluid otorrhea is often caused by the involvement of the tympanic cavity in the middle cranial fossa. After the fracture of the middle cranial fossa, the meninges in the upper middle ear are torn.
Skull base fracture (20%):
Ear leaks and rhinorrhea mainly suggest that a skull base fracture may occur, and because the infection may spread from the ear or nose to the meninges, there may be a risk of meningitis.
Tympanic membrane rupture (10%):
When the tympanic membrane is ruptured, it can cause cerebrospinal fluid to leak from the external auditory canal to form a cerebrospinal fluid otorrhea.
Prevention
Cerebrospinal fluid leakage prevention
A reasonable diet can take more high-fiber and fresh vegetables and fruits, balanced nutrition, including essential nutrients such as protein, sugar, fat, vitamins, trace elements and dietary fiber, with a combination of vegetarian and vegetarian foods. The complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Cerebrospinal fluid leakage complications Complication, disturbance of consciousness, headache, cerebral palsy
1. Cerebrospinal fluid is a serious complication of craniocerebral injury.
2. If the cerebrospinal fluid flows out of the open wound, the cranial cavity communicates with the outside world to form a leak, and at the same time, the air can also reversely escape into the air cranium.
3. If the cerebrospinal fluid leaks directly from the ventricle through the penetrating wounds, it often leads to severe meningitis and encephalitis.
(1) cerebral palsy formation: when the intracranial pressure is significantly increased or the posterior cranial fossa space-occupying lesion, a pressure cone can be formed in the large hole of the occipital bone, and the pressure in the subarachnoid space of the spinal cord is reduced after the lumbar puncture, and the cerebellar tonsil may Embedding into the large hole of the occipital bone causes cerebral palsy to form, causing disturbance of consciousness, sudden respiratory arrest or even death.
(2) headache after lumbar puncture: multiple intracranial pressure is reduced, headache is obvious when sitting and standing, and symptoms are relieved when lying down. Severe with nausea and vomiting. In order to prevent this complication, the lumbar puncture should be as small as possible. When the needle is inserted, the bevel of the needle tip should be parallel to the axis of the spine to avoid damage to the cerebrospinal fluid caused by the damage of the spinal cord. The amount of liquid discharged is not too much, generally 2 to 4 ml, not more than 10 ml. At least go to the pillow for 4-6 hours after surgery. Once the symptoms of low intracranial pressure appear, it is advisable to drink more water and rest in bed. In severe cases, you can take 1000-1500 ml of normal saline daily.
Symptom
Cerebrospinal fluid leakage symptoms Common symptoms Panda eye cerebrospinal fluid rhinorrhea olfactory loss on the conjunctiva appears on the conjunctiva can have skin sputum,...
Cerebrospinal fluid rhinorrhea is more common in anterior cranial fossa fractures. Acute patients often have bloody fluids overflowing from the nasal cavity after injury. Eyelid subcutaneous blood stasis (commonly known as panda eyes), ocular submucosal hemorrhage may be accompanied by olfactory loss or loss, occasionally injury In patients with optic nerve or oculomotor nerve, delayed cerebrospinal fluid rhinorrhea often occurs during the period after the fracture of the anterior cranial fossa. Due to the sudden cough, when the intracranial pressure suddenly increases, the meningeal hole is cracked and the liquid leaks out. The cerebrospinal fluid, generally in the patient sit up, the leakage increases when the head is lowered, and stops when lying down, because the liquid flows to the posterior nasal orifice and swallows in the supine position, or accumulates in the sphenoid sinus and other nasal sinus cavities, so this type The patient had more discharge when he got up in the morning.
Examine
Examination of cerebrospinal fluid leakage
1. Skull X-ray film can understand whether there is a fracture across the nasal sinus or rock bone.
2. CT scan can help to find out whether there is a gas skull, and observe the skull base fracture through the window position adjustment.
3. Radionuclide cerebral angiography: 131I-labeled human serum albumin (HISA), 99mTc or 169Yb-DTPA can be injected into the subarachnoid space through the lumbar cerebral ventricle, and the leaky site or water-soluble contrast agent can be observed. (Metrizamide) is injected into the subarachnoid space, the patient's position is adjusted under fluoroscopy, the contrast agent is introduced into the brain pool at the bottom of the brain, and then a thin CT scan of the skull base is performed to show the leak site.
Diagnosis
Diagnosis and diagnosis of cerebrospinal fluid leakage
If the tympanic membrane is ruptured, the discharge will flow through the external auditory canal. When the tympanic membrane is intact, the cerebrospinal fluid can flow through the eustachian tube to the pharynx, even from the posterior nasal orifice to the nasal cavity and then overflow from the nostril. It is similar to the nasal leakage caused by the anterior fossa fracture, which is easy to be misdiagnosed. Should be noted to be identified by means of auxiliary examination.
Diagnosis is not difficult. If there is less cerebrospinal fluid and more blood, it is difficult to identify with simple bleeding. At this time, the liquid can be dripped on the absorbent paper or gauze. If there is a circle around the blood, it will be wet. A circular blush can be used to determine the mixture of cerebrospinal fluid. Intermittent or small amounts of leakage should be differentiated from allergic rhinitis or vasomotor rhinitis. If the tympanic membrane is ruptured, the discharge will flow through the external auditory canal. When the tympanic membrane is intact, the cerebrospinal fluid can flow through the eustachian tube to the pharynx, even from the posterior nasal orifice to the nasal cavity and then overflow from the nostril. It is similar to the nasal leakage caused by the anterior fossa fracture, which is easy to be misdiagnosed. Should be noted.
