CASE REPORT
Introdução: As fístulas liquóricas nasais são comunicações do espaço subaracnoide com a cavidade nasal ou seios paranasais, de etiologia traumática ou não-traumática. A descontinuidade na base craniana resulta em escape de líquor através da nasofaringe. Os sintomas mais frequentes são rinorreia hialina unilateral, que piora ao abaixar a cabeça ou realizar algum esforço físico, cefaleia, náuseas e vômitos. Relato de caso: Caso de fístula liquórica rinogênica por iatrogenia pós teste para covid-19 por swab nasal, na qual houve a necessidade de fechamento cirúrgico. Paciente de 56 anos encaminhada ao serviço hospitalar após iniciar com quadro de rinorreia hialina após teste com swab nasal para covid-19, que resultou na formação de uma fístula liquórica nasal à esquerda. Após dias em tentativas de tratamento conservador, sem resolução do quadro, a paciente foi submetida a uma septoplastia com confecção de retalho septal para fechamento posterior da fístula. Conclusões: Diante do cenário atual de pandemia, é de grande relevância a documentação de casos de fístula liquórica para a preparação de profissionais que realizam os testes, frente ao uso demasiado destes durante a pandemia, pois pode acarretar graves prejuízos e riscos à saúde dos pacientes.
Background: Nasal cerebrospinal fluid fistulas are communications from the subarachnoid space with the nasal cavity or paranasal sinus, of traumatic or non-traumatic etiology. A discontinuity in the cranial base results in cerebrospinal fluid escape through the nasopharynx. The most common symptoms are unilateral hyaline rhinorrhea, which worsens by lowering the head or performing some physical exertion, headache, nausea, and vomiting. Case presentation: A case of rhinogenic liquic fistula by iatrogenic post-test for covid-19 by nasal swab, given the high frequency of these tests in the current pandemic scenario is reported. A 56-year-old patient referred to the hospital after starting with hyaline rhinorrhea after a test with nasal swab for covid-19, which resulted in the formation of a nasal cerebrospinal fluid fistula on the left nasal cavity. After days of attempting conservative treatment, without resolution of the condition, the patient was submitted to a septoplasty with septal flap for posterior closure of the fistula. Conclusions: Given the current pandemic scenario, it is of great relevance to document cases of nasal cerebrospinal fluid fistula for the preparation of professionals who perform the tests, given the use of these during the pandemic, as it can bring serious damage and risks to the health of patients.
1. Jerónimo A, Amaral A, de Sousa V, Eliseu A, Gama E, Barros E. Fístulas de LCR: encerramento por cirurgia endoscópica nasossinusal. Rev Port ORL. 2013;51(4):227-33. http://dx.doi.org/10.34631/sporl.46.
2. Giannetti AV, Santiago APMS, Crosara PFTB, Guimarães RES. Fístula liquórica da base anterior do crânio: classificação, clínica e diagnóstico. JBNC. J Bras Neurocirurg. 2011;22 (1):72-81. http://dx.doi.org/10.22290/jbnc.v22i1.1511.
3. Pin LC, Sposito MP, Botti A, Lima FOBB, Ribeiro FR. Discussão de casos: fístula Liquórica Rinogênica. Revista Científica Multidisciplinar Núcleo do Conhecimento. 2019;4(2):102-11. Edição 1.
4. Chan TLH, Cowan R, Hindiyeh N, Hashmi S, Lanzman B, Carroll I. pinal cerebrospinal fluid leak in the context of pars interarticularis fracture. BMC Neurol. 2020;20(1):162. http://dx.doi.org/10.1186/s12883-020-01740-1. PMid:32349710.
5. Styliaras JC, Dalyai R, Amgad H, Sharan A, Harrop J. Cerebrospinal fluid leaks from penetrating injuries: diagnosis and treatment. ArgoSpine News J. 2012;24(3-4):183-7. http://dx.doi.org/10.1007/s12240-012-0062-x.
6. Peer RF, Shabir N. Iatrogenesis: a review on nature, extent, and distribution of healthcare hazards. J Family Med Prim Care. 2018;7(2):309-14. http://dx.doi.org/10.4103/jfmpc.jfmpc_329_17.PMid:30090769.
7. World Health Organization. International Drug Monitoring: the Role of National Centres. Report of a WHO meeting. Geneva: WHO; 1972. World Health Organization technical report series; 498.
8. Tavares, FM. Reflexões acerca da iatrogenia e educação médica. Rev Bras Educ Med. 2007;31(2):180-5. http://dx.doi.org/10.1590/S0100-55022007000200010.
9. Alberola-Amores FJ, Valdeolivas-Urbelz E, Torregrosa-Ortiz M, Álvarez-Sauco M, Alom-Poveda J. Meningitis due to cerebrospinal fluid leak after nasal swab testing for COVID-19. Eur J Neurol. 2021;28(11):e91-2. http://dx.doi.org/10.1111/ene.14736. PMid:33480112.
10. Guimarães RES, Becker HMG, Giannetti AV, Crossara PFTB, Becker CG, Nogueira LM. Rinite vasomotora pós-cirúrgica: diagnóstico diferencial de rinoliquorréia. Rev Bras Otorrinolaringol. 2003;69(2):252-5. http://dx.doi.org/10.1590/S0034-72992003000200016.
11. Monjas-Cánovas I, Belinchón-Romero I, Gras-Albert JR, González-Alcaide G, Ramos-Rincón JM. Artigos mais citados sobre fístula liquórica (rinorreia e otorreia)(1945–2018). Rev Bras Otorrinolaringol. 2021;87:557-71. http://dx.doi.org/10.1016/j.bjorlp.2021.07.006.
12. Kljajić V, Vuleković P, Vlaški L, Savović S, Dragičević D, Papić V. Endoscopic repair of cerebrospinal fluid rhinorrhea. Braz J Otorhinolaryngol. 2017;83(4):388-93. http://dx.doi.org/10.1016/j.bjorl.2016.04.024. PMid:27320657.
13. Minas Gerais. Governo do Estado. Secretaria de Estado de Saúde. Subsecretaria de Vigilância em Saúde. COVID-19: Manual do Diagnóstico. Available from: https://coronavirus.saude.mg.gov.br/images/1_2021/01-boletim/04-abril/23-04-_Atualizacao_Manual_de_Diagnostico__Versao_4.pdf. Accessed: 17/3/2022.
14. Agamawi YM, Namin A, Ducic Y. Cerebrospinal fluid leak from COVID-19 swab. OTO Open. 2021;5(4):2473974X211059104. http://dx.doi.org/10.1177/2473974X211059104.
15. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016;6(1):8-16. http://dx.doi.org/10.1002/alr.21637. PMid:26370330.
16. LINDSAY KW, Bone I, Fuller G. Neurology and neurosurgery illustrated. 5th ed. London: Churchill Livingstone/Elsevier; 2010.
17. Häni L, Fung C, Jesse CM, et al. Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension - a matter of time. J Neurol. 2022;269(3):1439-46. http://dx.doi.org/10.1007/s00415-021-10710-7. PMid:34274993.
18. Gandhi J, DiMatteo A, Joshi G, Smith NL, Khan SA. Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management. Int J Neurosci. 2021;131(7):689-95. http://dx.doi.org/10.1080/00207454.2020.1751625. PMid:32242448.
1 Medical student, University Paranaense – UNIPAR, Umuarama, PR, Brazil.
2 MD, Neurosurgeon, Neurosurgery Service, Norospar Hospital, Umuarama, PR, Brazil.
3 Professor, Medicine Course, University Paranaense – UNIPAR, Umuarama, PR, Brazil.
4 MD, Otorrhinolaryngologist, ORL Service, Norospar Hospital, Umuarama, PR, Brazil.
Received Mar 17, 2022
Accepted Mar 29, 2022
