A 20-year-old’s runny nose that he had been suffering for six years turned out to be his brain bulging through a hole in his skull.
The unidentified man from Syria had been suffering a chronic runny nose, headaches and seizures after having experienced a head injury.
What he thought was simply a cold symptom was actually ‘leakage’ of cerebrospinal fluid (CSF) – a clear fluid that protects the brain and spine.
The issue began after the patient was in a car accident six years prior where he sustained a head injury but refused medical treatment at the time. He then began experiencing moderate headaches and seizures, as well as a runny nose.
The 20-year-old unnamed patient had been experiencing leakage of his cerebrospinal fluid for six years (stock photo)
After imaging was taken of the man’s brain, doctors diagnosed him with traumatic encephalocele, a condition in which brain matter escapes through openings in the skull, such as the nasal cavity.
Most often, an encephalocele is a rare birth defect that results in the tissue that covers the brain, and possibly portions of the brain itself, to protrude through openings in the skull.
The birth defect occurs in approximately one per 10,400 births, or about 375 babies a year.
In some cases, however, people can develop a traumatic encephalocele after experiencing some kind of trauma or injury to their head or brain, and the condition can develop years after the initial injury if the patient refuses treatment.
Because the condition is so rare, there are no known figures on how many traumatic encephaloceles occur in the US per year.
However, one study estimates a nasal encephalocele, like the one the 20-year-old had, occurs in one in 40,000 live births in the US per year.
According to the Syrian patient’s case report, about 10 to 30 percent of skull base fractures develop CSF leakage.
Losing CSF can damage blood supply to the brain and brain function. It also increases the risk of brain injury because CSF acts as a protective cushion for the organ.
Any type of encephalocele is treated with surgery to repair the rupture and close any open layers to ensure no more tissue or brain matter can drain out of the skull.
In the case of the Syrian patient, the man refused initial treatment for injuries when he was brought to the hospital after his car accident.
After suffering from headaches and seizures for years, the man developed meningoencephalitis two months before reporting to the hospital for his CSF nasal leakage.
He was admitted to the intensive care unit for one month and underwent an MRI of his brain.
This scan revealed he had a fracture in his skull and an encephalocele had developed in his nasal cavity.
His brain tissue and meninges – layers that protect the brain and spine – were bulging through the skull fracture with ‘significant expansion’ into right-side areas of the brain filled that are filled with CSF.
The left image shows the man’s encephalocele in his nasal cavity and the right image the resolution of the man’s encephalocele in his nasal cavity after surgery
The left image shows the encephalocele that has pushed through the patient’s skull into his nasal cavity and the right image shows the patient’s brain after removal of the encephalocele
Doctors recommended surgery to repair the fracture, but the patient refused medical care.
When he returned to the hospital two months later for a follow up, another MRI showed the same thing and surgery was again recommended.
The patient finally relented and underwent an operation that saw a neurosurgeon return the tissue and matter that had leaked through the patient’s nasal cavity back into their normal locations.
The doctor also repaired the damaged meninges and reconstructed the base of the skull where the fracture had damaged it with medical-grade cement and glue.
The patient recovered well and was sent home two days later.
At a follow-up visit two months later, an MRI revealed the patient’s encephalocele was completely closed and any damage the bulging matter had on the brain and surrounding areas had been reversed.
The man also stopped having headaches, a runny nose and seizures.
Doctors in the case report warned that although a traumatic encephalocele is ‘a rare and unexpected complication of trauma,’ doctors must evaluate patients for it ‘because of it’s life-threatening consequences.’
