Post-Traumatic (Severe Head Injury) Complicated into Left Cerebrospinal Fluid (CSF) Rhinorrhea, Pneumocephalus, Skull Base Fracture, Deviated Nasal Septum

A relatively rare case of Cerebrospinal Fluid (CSF) rhinorrhea accompanied by pneumocephalus with a deviated nasal septum is reported in a young, elderly man who met with alleged Road Traffic Accident (RTA) and self-fell from a two-wheeler, who arrived with the chief complaints of loss of consciousness, nose bleeding, discharge from the nose, and 1 episode of seizures occurring before 5 days of this incident. Upon evaluation, blood investigations showed elevated total counts. CT cisternogram revealed no fill of contrast was injected into the intrathecal space at the L3-L4 level through lumbar puncture under local anesthesia. Evidence of leakage of contrast-filled Cerebrospinal Fluid (CSF) is seen into the sinus through the roof of the sphenoid and sphenoethmoidal recess. Fractures noted in the roof of the sphenoid-Cerebrospinal Fluid (CSF) rhinorrhea. Gross pneumocephalus noted. Fracture of the lesser wing of the sphenoid on the left side. Other fractures seen in the base of bones in the CT scan done. Later, an ENT appointment was requested due to Deviated Nasal Septum (DNS) and left CSF rhinorrhea. Based on the ENT surgeon’s pre-anesthesia checkup, he underwent left FESS+left sphenoid CSF leak repair+endoscopic septoturbinoplasty was done under General Anesthesia (GA). The postoperative period was uneventful, with the patient receiving IV antibiotics, antituberculars, and supportive care. A follow-up CT brain scan showed stable CSF rhinorrhea, air in the left lateral ventricle, and post-surgical changes from transsphenoidal surgery. CT cisternogram revealed no new leaks, and the patient gradually improved symptomatically.