“6 years of runny nose, ‘this’ came from the brain?”…20-year-old male’s brain herniation, what could it be?

A case report has been published of a patient whose persistent runny nose for six years was actually discovered to be cerebrospinal fluid.

A 20-year-old male patient from Syria was taken to the hospital after suffering a head injury in a traffic accident six years ago. However, he refused treatment and since then suffered from headaches, seizures, and a persistent runny nose. Recently, the man was admitted to the intensive care unit with meningitis and was treated. An MRI scan performed there revealed a basilar fracture of the skull, which caused part of the brain to protrude into the nasal cavity. The medical team diagnosed a traumatic brain herniation (encephalocele) and recommended surgery to repair the fracture, but the patient again refused treatment.

However, two months later, the same problem was still found in the follow-up examination, so the medical team recommended surgery again, and this time the patient agreed to undergo the surgery. The medical team performed the surgery to return the tissue and brain substance that had leaked into the nasal cavity to their original positions, and reconstruct the fractured skull base with medical bone cement and adhesive. The patient recovered after the surgery and was discharged two days later. Two months later, the examination confirmed that the surgery was successful, and the patient reported that the headache, seizure, and runny nose symptoms had disappeared.

This case was reported in the Journal of Medical Case Reports.

Brain herniation, which occurs primarily in newborns as a result of neural tube defects

Brain herniation is a congenital or traumatic protrusion of the brain tissue through an opening in the skull. It is a condition caused by neural tube defects that most often occur in newborns. The neural tube forms the early brain and spine, and brain herniation can occur if the neural tube does not close completely in early pregnancy. According to the Fetal Medicine Foundation (FMF), it occurs in about 1 in 5,000 newborns.

Babies with a herniated brain are born with brain tissue protruding through an opening in the skull. It can occur anywhere along the center of the skull from the nose to the back of the neck, but it is most commonly found on the back and top of the head, between the forehead and nose.

In some cases, brain herniation occurs after a head or brain injury, especially if the initial injury is not treated, and symptoms may not begin until years later. According to the Centers for Disease Control and Prevention (CDC), traumatic brain herniation is so rare that there are no accurate statistics on the actual incidence.

If there is a brain herniation, symptoms may include excessive accumulation of cerebrospinal fluid, loss of arm and leg strength, developmental delay and intellectual disability, vision problems, and seizures.

The medical team in question reported that 10-30% of skull fractures result in cerebrospinal fluid leakage. Since cerebrospinal fluid plays a role in protecting the brain, a cerebrospinal fluid leak can damage the blood supply and function of the brain.

Brain herniation does not have all the known causes, but certain factors may increase the risk. According to the CDC, low folate levels in early pregnancy, poorly controlled pre-existing conditions such as diabetes, certain medications such as anticonvulsants, and overheating and fever are known to increase the risk.

Treatment involves placing the protruding portion back into the skull and closing the opening to prevent further leakage.