traumatic cerebrospinal fluid leak
Introduction
Introduction to traumatic cerebrospinal fluid leakage Traumatic cerebrospinal fluid leakage is caused by open brain injury. Cerebrospinal fluid leakage at the base of the skull can be divided into three types: nasal leakage, ear leakage, and eye leakage. The former two are more common. Nasal leakage, mostly due to fracture of the sieve plate, fracture of the frontal sinus wall, a small number due to sphenoid sinus fracture. Occasionally, the fracture of the rock bone, the tympanic membrane is not broken, and the cerebrospinal fluid flows into the nasal cavity through the eustachian tube. Otorrhea, more common in the fracture of the tympanic cavity of the rock bone, the dural rupture can be in the middle of the cranial fossa or the posterior cranial fossa, the former is more common. basic knowledge The proportion of illness: 0.012% Susceptible people: no special people Mode of infection: non-infectious Complications: fracture meningitis pneumonia
Cause
Traumatic cerebrospinal fluid leakage
Skull fracture (25%):
The dura mater at the base of the skull is closely adhered to the skull base, and there is a multifibrous adhesion between the dura mater and the arachnoid membrane. The fracture is often accompanied by a dural tear and arachnoid tear. Cerebrospinal fluid leakage occurs, so cerebrospinal fluid leakage occurs in the skull base fracture. Cerebrospinal fluid flows out through the nasal cavity, ear canal or open wound, which is a serious complication of craniocerebral injury, which can lead to intracranial infection.
Traumatic penetrating injury (33%):
Cerebrospinal fluid wound leakage (leakage) caused by penetrating brain injury is often caused by incomplete debridement and poor repair of dura mater, and is more likely to occur in patients with penetrating cerebral ventricle.
High intracranial pressure (15%):
The time of occurrence of cerebrospinal fluid leakage is quite different, most of which occur immediately after injury or within a few days. It is an acute phase of cerebrospinal fluid leakage; but there are also a few patients who appear several months or even years later, called delayed cerebrospinal fluid leakage. Most of the former self-closed and healed in about 1 week; once the latter appears, it often prolongs and heals, and when it stops, it often leads to secondary intracranial infection, recurrent meningitis, and the cause of delayed cerebrospinal fluid leakage may be related to Local wounds after traumatic brain injury, edema of brain tissue, temporarily blocking the dural rupture of the dura mater, after the blood clot is dissolved, absorbed, and the cerebral edema subsides, but also due to some factors that suddenly increase the intracranial pressure, such as exertion , cough, sneezing, etc., so that the weak cracks leak, fortunately, the mortality rate of meningitis in this type of patients is significantly lower than that of meningitis patients, and it is also estimated to be related to the drainage of cerebrospinal fluid leakage.
Prevention
Traumatic cerebrospinal fluid leakage prevention
Prevent infection, prevent increased intracranial pressure, create conditions to promote natural healing of the pupil, take the head high position, limit the amount of drinking water and salt intake, avoid coughing and blowing nose, prevent constipation.
Complication
Traumatic cerebrospinal fluid leakage complications Complications, meningitis, pneumonia
Cranial nerve damage
Cerebrospinal fluid rhinorrhea caused by fracture of the sieve plate may be accompanied by loss of one or both sides of the olfactory. Individual sphenoid sinus fractures or ocular sinus injuries may be accompanied by optic nerve or ocular motor nerve dysfunction. After the fracture of the rock bone, facial nerve and auditory nerve injury often occur. The rates were 19.8% and 31.4%, respectively, and occasionally nerve or trigeminal nerve injury.
2. Intracranial infection
The biggest hazard of cerebrospinal fluid leakage is meningitis, which can be repeated and repeated attacks. The pathogens are mostly Staphylococcus aureus and pneumococci.
Symptom
Traumatic cerebrospinal fluid leakage symptoms Common symptoms Olfactory loss Panda eyes Cerebrospinal fluid Rhinorrhea Eye conjunctiva appears on the conjunctiva
Leaky cerebrospinal fluid
It occurs more immediately after the injury, but also occurs several months after the injury. In some cases, the early leakage can heal itself, and it will reappear after several months to several years. Some patients have leakage in a specific body position, and the acute phase flows out. The cerebrospinal fluid often has a blood color, and turns yellow in a little while, and turns into a clear water in the chronic phase.
Acute patients often have bloody fluids overflowing from the nasal cavity, subcutaneous blood stasis (commonly known as panda eyes), ocular sub-membrane hemorrhage, may be associated with loss of olfactory or decreased, occasionally also injured optic nerve or oculomotor nerve, delayed cerebrospinal fluid The 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 pores are cracked, and the liquid leaks out as a clear cerebrospinal fluid, usually in the patient's seat. When the leakage increases, it 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 paranasal sinus cavities. Therefore, such patients have more discharge when they wake up in the morning.
Cerebrospinal fluid otorrhea is often caused by the involvement of the tympanic cavity in the middle cranial fossa fracture. Because the rock bone is located in the cranium, at the junction of the posterior fossa, regardless of the fracture of the middle or posterior fossa of the rock bone, as long as the middle ear cavity is injured, it can be bloody. The cerebrospinal fluid enters the tympanic cavity. If the tympanic membrane is ruptured, the discharge flows out through the external auditory canal. When the tympanic membrane is intact, the cerebrospinal fluid can flow through the eustachian tube to the pharynx, and even from the posterior nasal orifice to the nasal cavity and then overflow from the nostril, resembling the nasal leak caused by the anterior fossa fracture. It is easy to be misdiagnosed. It should be noted that facial nerve and auditory nerve injury and nerve or trigeminal nerve injury often occur after fracture of the bone. In addition, delayed subcutaneous ecchymosis (Battle sign) in the posterior mastoid region is also common in shale fractures. Signs.
Cerebrospinal fluid wound leakage (leakage) is almost caused by improper treatment of open craniocerebral injury at the initial stage. It is more common in firearm penetrating trauma because of poor dural repair or poor healing due to wound infection. If cerebrospinal fluid leakage comes directly from When the ventricle wears a penetrating wound, there is often a large amount of cerebrospinal fluid loss, not only the general condition is low, but also often causes severe meningitis and encephalitis, especially in children, it is necessary to debride and repair in time.
2. Headache, dizziness
Due to the loss of cerebrospinal fluid, leakage of fluid can cause low intracranial pressure syndrome.
Examine
Traumatic cerebrospinal fluid leakage examination
Radioisotope inspection
The 131A-RISA, 99mTC and other nuclides were used for lumbar subarachnoid injection, followed by ECT scanning or gamma-irradiation, sometimes showing the sputum.
2. Skull X-ray film
Most of the rhinorrhea can be found in the frontal bone, frontal sinus, dome, sieve plate or sphenoid bone fracture. Sometimes the liquid level is visible in the paranasal sinus. The ear canal can be seen as a fracture of the rock bone, and the mastoid air chamber is blurred.
3. Brain CT scan
CT scan is the only method that can show the leakage of cerebrospinal fluid. The positive rate of plain scan can reach 50%, and the scan after brain cerebral angiography can reach 69%. When scanning, different methods should be used for different parts. Generally, the amount is crowned. Scanning and sagittal reconstruction, three-dimensional image observation for diagnosis.
Diagnosis
Diagnosis and diagnosis of traumatic cerebrospinal fluid leakage
The diagnosis of cerebrospinal fluid leakage is first to determine the nature of the discharge. The cerebrospinal fluid has a high sugar content, so it can be measured by "urine sugar test paper". Sometimes the leakage liquid is mixed with blood. The biochemical measurement is difficult to confirm, so the red blood cell counting method can be used to compare the leakage. The blood and blood blood counts are used to determine, but the exact diagnosis still depends on the special examination method: the skull X-ray film can understand whether there is a fracture across the paranasal sinus or rock bone; CT scan helps to find the presence or absence of a gas skull And observe the skull base fracture through the window position adjustment; radionuclide cerebral angiography, 131I-labeled human serum albumin (HISA), 99mTc or 169Y-DTPA can be injected into the subarachnoid space by cerebral ventricle. The leaky site or the water-soluble contrast agent (Metrizamide) is injected into the subarachnoid space, the patient's body position is adjusted under fluoroscopy, the contrast agent enters 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. Hole part.
