Neurosurgical complications of head injury

Peter C. Whitfield, Laurence Watkins

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Skull base fracture – CSF leak. CSF rhinorrhoea or otorrhoea indicates that a skull base fracture has breached the dura and formed a communication between the intracranial contents and the external environment. This places the patient at risk of meningitis while the CSF leak continues. Since 90% of cases seal spontaneously within 2 weeks, neurosurgical intervention is not usually considered until this time has elapsed. An exception is a fracture of the posterior wall of the frontal sinus where a persistent leak is likely. Early anterior fossa repair is normally considered in such cases (see Chapter 18). Sometimes a CSF leak is clinically obvious. If a leak is suspected but not overt, leaning the patient's head forward may provoke a characteristic nasal drip. Further provocation can be sought by laying the patient prone with the head dependant over the end of the couch. However, a small amount of clear nasal fluid can be of doubtful significance. It can be difficult to differentiate between CSF and thin nasal mucus, particularly if the discharge is also stained by blood after trauma. Since CSF and blood both contain glucose, and nasal secretions can contain glucose, the sensitivity and specificity of a positive glucose oxidase strip test are poor. The τ-fraction of transferrin, known as τ-transferrin, τ-protein, τ-globulin, β2transferrin, asialotransferrin or more commonly tau protein, is present in normal CSF and absent from the blood except in patients with sustained alcohol abuse and rare carbohydrate deficient glycoprotein syndromes. If a sample of fluid can be collected, then a relatively quick laboratory test for tau protein can confirm CSF leakage.

Original languageEnglish
Title of host publicationHead Injury
Subtitle of host publicationA Multidisciplinary Approach
PublisherCambridge University Press
Pages201-212
Number of pages12
ISBN (Electronic)9780511576515
ISBN (Print)9780521697620
DOIs
Publication statusPublished - 1 Jan 2009

ASJC Scopus subject areas

  • General Medicine

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