COVID-19 nasopharyngeal swab and cribriform fracture

Vasilica, A.M; Reka, A; Mallon, D; Toma, A.K; Marcus, H.J; Pandit, A.S

COVID-19 nasopharyngeal swab and cribriform fracture

Authors

Vasilica, A.M

Reka, A

Mallon, D

Toma, A.K

Marcus, H.J

Pandit, A.S

Issue Date

2023

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Microbiology, immunology, infectious diseases::Infectious diseases , Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Lung diseases

Abstract

Since the start of the pandemic, over 400 million COVID-19 swab tests have been conducted in the UK with a non-trivial number associated with skull base injury. Given the continuing use of nasopharyngeal swabs, further cases of swab-associated skull base injury are anticipated. We describe a 54-year-old woman presenting with persistent colourless nasal discharge for 2 weeks following a traumatic COVID-19 nasopharyngeal swab. A β2-transferrin test confirmed cerebrospinal fluid (CSF) rhinorrhoea and a high-resolution sinus computed tomography (CT) scan demonstrated a cribriform plate defect. Magnetic resonance imaging showed radiological features of idiopathic intracranial hypertension (IIH): a Yuh grade V empty sella and thinned anterior skull base. Twenty-four hour intracranial pressure (ICP) monitoring confirmed raised pressures, prompting insertion of a ventriculoperitoneal shunt. The patient underwent CT cisternography and endoscopic transnasal repair of the skull base defect using a fluorescein adjuvant, without complications. A systematic search was performed to identify cases of COVID-19 swab-related injury. Eight cases were obtained, of which three presented with a history of IIH. Two cases were complicated by meningitis and were managed conservatively, whereas six required endoscopic skull base repair and one had a ventriculoperitoneal shunt inserted. A low threshold for high-resolution CT scanning is suggested for patients presenting with rhinorrhoea following a nasopharyngeal swab. The literature review suggests an underlying association between IIH, CSF rhinorrhoea and swab-related skull base injury. We highlight a comprehensive management pathway for these patients, including high-resolution CT with cisternography, ICP monitoring, shunt and fluorescein-based endoscopic repair to achieve the best standard of care. Keywords: COVID-19 nasopharyngeal swab; Cribriform fracture; Endoscopic transnasal surgery; Idiopathic intracranial hypertension; Skull base repair. PubMed Disclaimer

Citation

Vasilica AM, Reka A, Mallon D, Toma AK, Marcus HJ, Pandit AS. COVID-19 nasopharyngeal swab and cribriform fracture. Ann R Coll Surg Engl. 2023 Aug;105(S2):S69-S74. doi: 10.1308/rcsann.2022.0128. Epub 2023 Mar 16. PMID: 36927165; PMCID: PMC10390246.