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Archivos de Medicina Interna

Print version ISSN 0250-3816On-line version ISSN 1688-423X

Abstract

JAUME, Alejandra et al. Post-traumatic cerebrospinal fluid fistula: proposal of diagnostic and therapeutic algorithm. Arch. Med Int [online]. 2015, vol.37, n. 1, pp.47-52. ISSN 0250-3816.

Introduction: the cerebrospinal fluid (CSF) fistula is defined as the abnormal leak of fluid from the skull to outside the body through an osteomeningeal gap, which allows the passage of organisms to the intra-cranial space, with the risk of infection, potentially life-threatening. Divided as traumatic and non-traumatic, the condition is relatively common, and poses great challenges to neurosurgeons. Objective: to present the first case of post-traumatic CSF fistula in Uruguay, assessed with cistern MRI with diagnostic purposes. Case report: the case described is that of a patient that received treatment at the University Hospital (Hospital de Clínicas). The case is used to illustrate the condition and review the latest controversial issues involved in the algorithms for the diagnosis and therapy of the condition. Discussion: the main controversial issues found included the following: when to start prophylactic antibiotic (ATB) therapy following diagnosis; imaging tests requested for diagnosis, and type of therapy prescribed. Conclusions: the review of literature leads us to conclude that a correct diagnosis requires the routine use of CT and MRI; if doubts persist, cistern MRI, endoscopy, or cistern CT are indicated. With regards the therapeutic algorithm, we conclude that therapy should be conservative, applying medical therapy for two to four weeks; surgery will be prescribed if the fistula persists after that. Antibiotic therapy is an option and not a recommendation.

Keywords : fistula; CSF; nasal CSF leaks; ear CSF leaks; meningitis; skull base fracture; surgery.

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