[Clinical analysis of 8 cases of spontaneous cerebrospinal fluid rhinorrhea with aspiration pneumonia]

Abstract

Objective: To investigate the clinical characteristics, treatment, and efficacy of spontaneous cerebrospinal fluid rhinorrhea (CFR) combined with aspiration pneumonia. Methods: In this case series study, a total of 8 patients diagnosed with spontaneous CFR combined with aspiration pneumonia were admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Yuhuangding Hospital Affiliated with Qingdao University from March 2020 to March 2022. There were 3 males and 5 females, with ages ranging from 45 to 57 years. Endoscopic repair of CFR was performed for all patients. Retrospective analysis was conducted on the symptoms, chest CT findings, the leak location of CFR, and laboratory virological test results. The healing of the operative cavity and the recovery of pulmonary inflammation were followed up. Results: All the 8 patients had obvious postnasal cerebrospinal fluid drip with different degrees of dry cough, which was aggravated when lying flat and sleeping. Bone defects of CFR were predominantly located in the sphenoid sinus, lamina cribrosa and ethmoid roof. Chest CT scans upon admission showed multiple flocculent ground glass opacities and inflammatory changes in both lungs. Tests for TORCH (TOX, RV, CMV, HSV), EB (Epstein-Barr) virus nucleic acid, nine respiratory pathogens, 2019-nCoV oropharyngeal swab, and serum immunoglobulin(Ig)M/IgG were all negative. Seven patients were cured after endoscopic repair of CFR. CFR occurred again in one patient due to head trauma, and no recurrence was observed for 3 months after reoperation. Postoperative chest CT scans confirmed the resolution of aspiration pneumonia in all 8 patients. Conclusions: Aspiration pneumonia may arise from the aspiration of cerebrospinal fluid in patients with spontaneous CFR. Early diagnosis and timely repair of CFR contribute to the recovery of aspiration pneumonia.