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Case Reports
. 2017;56(14):1911-1914.
doi: 10.2169/internalmedicine.56.8186. Epub 2017 Jul 15.

Cerebrospinal Fluid Rhinorrhea and Subsequent Bacterial Meningitis due to an Atypical Clival Fracture

Rie Tohge  1 , Makio Takahashi  1
Affiliations
Case Reports

Cerebrospinal Fluid Rhinorrhea and Subsequent Bacterial Meningitis due to an Atypical Clival Fracture

Rie Tohge et al. Intern Med. 2017.

Abstract

Cases of cerebrospinal fluid (CSF) rhinorrhea due to clival fracture are rare. We present a case of bacterial meningitis with CSF rhinorrhea after a clival fracture. Heavily T2-weighted images showed a bone flap in the thinned clivus and fluid collection in the sphenoid sinus. CSF rhinorrhea developed at 1 month after mild trauma. The fracture may have been caused by the trauma and/or by the pressure gradient between the intracranial CSF space and the sphenoid sinus. A detailed history to identify trauma and an examination to detect bone defects in the skull base are necessary when patients present with bacterial meningitis and persistent rhinorrhea.

Keywords: bacterial meningitis; cerebrospinal fluid; clival fracture; rhinorrhea.

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Figures

Figure.
Figure.
A, B: Axial T1-weighted images with contrast showing enhancement in the interpeduncular cistern (arrowheads), the basal cistern around the pons (arrows), and the suprasellar cistern (arrowhead). C: Sagittal heavily T2-weighted images with FSE (TR 1500; TE 250) showing a bone gap with a flap (black arrows) in the thinned clivus and an enlarged sphenoid sinus filled with CSF (white arrows), due to a partial defect of the mucosa separating the sinus from the clivus (arrowheads). D, E: A displaced longitudinal clival fracture was observed in the bone window of head computed tomography (CT) (D; white arrow) and in the dorsal portion of the clivus on three-dimensional CT (E; black arrowheads). F: A 3-dimensional cranial base reconstruction of the clivus viewed from the sphenoid sinus showing a 3×4-mm circular bone defect (red arrowheads) with a flap on its edge in the center of the clivus (red arrow).
See this image and copyright information in PMC

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