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After being subjected to a nasal swab to test positivity by SARS-CoV-2 coronavirus, an American woman in her 40s began to lose liquid clean of nose, also experiencing headaches, Stiff neck, photophobia (intolerance to light) and The vomit. The lost liquid was the cerebrospinale fluid the cerebrospinal (CFR), a liquid that permeates the central nervous system with different functions: it protects the brain as a kind of “cushion” for shocks and regulates some physiological responses.
The health professional who performed the nasal swab on the woman practically pierced the lining of the brain causing fluid to leak, but this only happened because the patient had an undiagnosed condition, that is. encephalocele. In simple terms, it is a ‘brain herniation, which had developed right in the nasal cavity where the tampon is inserted. To make matters worse, the health worker probably did not perform a “state of the art” maneuver, reaching too high with the stick, as the patient claims. Following his case, three physicians Christopher Blake Sullivan, Adam T. Schwalje and Megan Jensen from the Departments of Otolaryngology – Head and Neck Surgery and Neurosurgery at the University of Iowa Hospital.
The woman had undergone another COVID swab some time before, and had not experienced any problems, while during the second swab, as indicated, she realized that the health worker was intervening with a different maneuver. After experiencing fluid loss and other complaints, doctors performed various tests and discovered a 1.8-centimeter encephalocele extending into the right ethmoid fovea from the middle meatus and also a pseudomeningocele. The woman had been operated on twenty years earlier to heal intracranial hypertension and to remove some nasal polyps; the pressure of the cerebrospinal fluid was too high, and doctors used a shunt to drain some of the fluid. This treatment likely led to the formation of the encephalocele, according to the experts, which was then affected by the operator during swabbing. This would have resulted in the loss of fluid from the nose. “To our knowledge, this is the first report of an iatrogenic CSF leak after a nasal swab for COVID-19,” the doctors wrote in their case report.
Perforation of the brain lining was a very rare case due to a combination of unfortunate circumstances (possible imperfect operator maneuver and presence of the encephalocele), so the study authors emphasize that tampons remain completely safe and that you take risks. However, in light of these rare eventualities, scientists emphasize the importance of proper training of personnel who must perform swabs and recommend the use of alternative methods for patients at risk. Details of the case report “Cerebrospinal fluid leak after nasal swab test for coronavirus disease 2019” have been published in the specialized scientific journal JAMA Otolaryngology-Head & Neck Surgery.
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