C A S E O F T H E M O N T H
SKULL FRACTURE WITH CSF LEAK
A 40-year-old man was repairing his garage door when it fell and hit him in the forehead. He was immediately brought to the nearest hospital for treatment.
On examination, he was awake, alert, and able to follow commands. There was a lacerated wound across his forehead, and the bone underneath seemed to be depressed. There was also leakage of watery fluid from his nose, which flowed more copiously when he was sitting up compared to when he was lying down.
CT scan of the brain showed slight bruising of the frontal lobes (the front part of the brain). There was a depressed fracture of the frontal bone (the bone at the forehead), as well as pneumocephalus or “air in the brain,” a sign that the outer covering of the brain may have been torn. This may be the reason why the patient had watery nasal discharge; the nasal discharge was most likely fluid from the brain that leaked out of the torn covering and out through the nose. The patient would require surgery to clean the dirty wound, repair the fluid leakage to prevent infection, and repair the skull fracture.
The operation went well and the patient stopped having fluid leakage from the nose after the surgery. He was given antibiotics to help prevent infection from the open fracture. He also underwent medical treatment and close observation for the bruising in the brain. He was discharged improved and subsequently made a full recovery. |
