Spontaneous Cerebrospinal Fluid Rhinorrhea Associated With Chronic Renal Failure. Case Report.

Abstract

A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. Neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca ＋＋ and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH 2 O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extraosseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca ＋＋ mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.

Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis

“…[6][7][8] Any thing that increases the intracranial pressure might open any already present occult anatomic defect. 9 Using CT cisternography we were not able to detect any occult malformation that could cause pneumocephalus in our patient.…”

“…1,3,4 Other locations (tentorium, convexity, anterior cranial fossa, cerebellopontine angle, Meckel's cave, sella turcica, internal auditory meatus or related to cranial nerves) are rarer, and only about 20 reports have been published. [3][4][5][6][7][8][9][10][11][12] Differential diagnosis includes other extra-axial enhancing tumours, mainly meningiomas.…”

Transethmoidal Meningoencephalocele Involving the Olfactory Bulb With Enlarged Foramina of the Lamina Cribrosa -Case Report-

“…Therefore, the olfactory bulb tissue had probably protruded, together with the arachnoid membrane, through the enlarged foramen and descended into the ethmoidal sinus, thus forming the meningoencephalocele. Only 2 cases of transethmoidal encephalocele associated with the olfactory bulb or nerves have been reported: one case involved the enlargement of the foramina of the lamina cribrosa and the olfactory nerve 24) ; in the other case, the thick olfactory nerve and brain tissues had descended into a defective lamina cribrosa and into the nasal cavity to form a large nasal tumor. 2) Almost all cases of transethmoidal encephalocele have been associated with congenital defect of the basal bone.…”

Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

“…Although GH therapy is rarely associated with intracranial hypertension in patients with renal failure [18], and then, mainly within the first 13 weeks of therapy [19], later onset has been reported in some cases. In addition, the severe hyperparathyroidism and the high-dose calcitriol pulse therapy could have produced microscopic arachnoid villi calcification which impaired CSF reabsorption [20].…”