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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 310-313
DOI: 10.4103/ajns.AJNS_179_18
Case Report

Meningitis for Streptococcus salivarius secondary to paradoxical cerebrospinal fluid rhinorrhea as a complication of retrosigmoid approach

María Vargas Osorio
Medicine Undergraduate, Universidad Militar Nueva Granada, Bogota
,
Juan Muñoz Montoya
1   Department of Neurosurgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogota
,
Marco Charry Lopez
2   Department of Neuroradiology, Hospital Militar Central, Bogota
,
Luis Rojas Romero
1   Department of Neurosurgery, Hospital Militar Central, Universidad Militar Nueva Granada, Bogota
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Rhinorrhea secondary to a retrosigmoid approach is rare, but when it manifests, it is due to a paradoxical cerebrospinal fluid (CSF) leak, as a result of the communication between the mastoid cells, middle ear, and eustachian tube, which finally ends on the release of CSF through the nasopharynx. Abnormal communications increases the risk of infections, not only at the surgical site but also through an ascending path. Magnetic resonance cisternography (MRC) with intrathecal gadolinium injection through a lumbar puncture not only allows an adequate diagnosis but also helps to establish management plans. Here, we present an eighty-three-year-old female patient, with a history of trigeminal neuralgia, who underwent retrosigmoid approach to perform trigeminal microvascular decompression. After intervention, the patient consulted for rhinorrhea, fever, and headache. Lumbar puncture was performed, resulting on the isolation of Streptococcus salivarius in CSF. Nuclear MRC with intrathecal gadolinium injection was performed, identifying a paradoxical CSF leak. Failure in medical management with conservative treatment ends in surgical reexploration, identifying a bone defect in mastoid cells, which was corrected.

Key-words:

Nuclear magnetic resonance cisternography - paradoxical cerebrospinal fluid rhinorrhea - retrosigmoid approach - Streptococcus salivarius

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Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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