A 40-year-old American woman suffered from complications that could have been fatal after a trivial PCR test, having pierced the wall of her brain and caused the leakage of cerebrospinal fluid. Explanations.
An undiagnosed anomaly
While the swab test can be off-putting, it is an essential tool in these times of a pandemic and is proven to be perfectly safe for the vast majority of people. Recently published in the journal Otolaryngology-Head and Neck Surgery, however, a study describes the case of a patient in whom it caused the leak of cerebrospinal fluid (LCR). In her forties, she presented with a rare anomaly that contributed to the injury. According to scientists, this is the only case of leaking LCR reported following a nasal swab.
The complication that led to the incident is related to the treatment the patient had received years before for intracranial hypertension, a condition where the LCR increases the pressure around the brain. At the time, a shunt had been used to drain excess fluid, which successfully treated the initial disorder but led to a silent complication known asencephalocele, resulting in the protrusion at the rear of the nasal passages of part of the brain wall.
As the abnormality was not diagnosed, the nasal swab performed for surgery led to the rupture of the wall. After the procedure, the patient noticed that a clear liquid was leaking from one of her nostrils, developed a headache, suffered from vomiting, a stiff neck as well as a strong sensitivity to light (photophobia). The scans performed by the doctors revealed the encephalocele, which was successfully treated during the operation that followed.
Consider alternatives to nasal screening in at-risk patients
As the authors of the study recall, a leak of LCR, a substance in which the brain bathes, represents a serious condition, because the rupture of the brain wall makes this organ vulnerable to infection and it is also possible for air to enter the skull through the created breach, thus increasing the intracranial pressure.
There are currently three types of nasal swabs that can be used to reveal an infection in the Covid-19, as well as two alternative diagnostic methods. Although nasal swabs are safe for patients with healthy nasal anatomy, researchers are still wondering whether past surgeries should be taken into account when deciding the most appropriate diagnostic test for specific patients.
” Previous surgery, or a condition that distorts normal nasal anatomy, may increase the risk of adverse events associated with nasal tests for respiratory pathogens, including Covid-19 », Write the authors in particular. ” Consideration should be given to alternative methods to nasal screening in patients with known prior skull base defects, a history of sinus or base skull surgery, or conditions predisposing to base skull erosion. “