Cerebrospinal fluid leak presenting as oculorrhea after blunt orbitocranial trauma.

Abstract

Cerebrospinal fluid (CSF) leak is an uncommon but well-documented occurrence after blunt head trauma, typically manifesting as otorrhea or rhinorrhea. Blunt cranio-orbital trauma also may cause CSF leak into the orbit, manifesting as orbitocele, blepharocele, chemosis, or tearing ("oculorrhea"). We report a patient who developed oculorrhea after blunt head trauma, and neuroimaging disclosed comminuted fractures of the left frontal, greater sphenoid wing, nasal, and maxillary bones. Because he also displayed chemosis and markedly reduced ocular ductions and periocular pain, carotid-cavernous fistula was suspected but appropriate vascular imaging was negative. Aspiration of subconjunctival fluid was positive for beta-2 transferrin, a specific marker for CSF. Chemosis lessened and the oculorrhea ceased spontaneously within 6 days of the trauma. This manifestation of CSF leak must not be overlooked because of the threat of meningitis.

• Authors: Alexandra O Apkarian, Shawn L Hervey-Jumper, Jonathan D Trobe
• Journal: Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society (J Neuroophthalmol) Vol. 34 Issue 3 Pg. 271-3 (Sep 2014) ISSN: 1536-5166 [Electronic] United States
• PMID: 24621864 (Publication Type: Case Reports, Journal Article)

Topics

• Accidents, Traffic
• Adult
• Cerebrospinal Fluid Leak (etiology)
• Craniocerebral Trauma (complications)
• Humans
• Male
• Ocular Motility Disorders (physiopathology)
• Tomography Scanners, X-Ray Computed