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October 2, 2020
A woman with a skull base defect was found to have a spinal fluid leak after getting a nasal swab test for the coronavirus, according to a new study, in what researchers say is the first such case.
After getting a coronavirus test before an elective hernia surgery, a woman in her 40s started experiencing a headache, nausea, light sensitivity and drainage of clear fluid from one side of her nose, Christopher Blake Sullivan, a physician at the University of Iowa Hospitals and Clinics, told The Washington Post.
“We were able to identify that she had a spinal fluid leak, called a cerebrospinal fluid leak,” said Sullivan, the study’s lead author.
“What is the likely reason that happened is she had nasopharyngeal swab testing done for covid,” he said, referring to coronavirus tests done with a long nasal swab.
Jarrett Walsh, an assistant professor at the University of Iowa and a study co-author, said the woman had a predisposing condition of intracranial hypertension, which is increased pressure in the fluid space around her brain, which led to the formation of a sac of brain fluid and tissue that bulged down into the sinus cavity.
“We presume the nasal swab was targeted in the wrong direction and may have punctured that sac that was hanging into her nose, thus causing the fluid leak,” Walsh told The Post.
In the article, the researchers write that “the swab itself did not result in a violation of the bony skull base, but rather the invasive test” penetrated the area with the preexisting defect.
Sullivan said the patient, who had also had a sinus surgery about two decades earlier, was probably in a “higher risk category for getting covid testing.”
Still, Walsh said this is a “very rare occurrence.” Even for people with similar preexisting conditions or who have had sinus or skull base surgery, “your risk of having this happen is exceedingly low.”
The researchers said the findings signal a need for better training on safely conducting nasal and nasopharyngeal swab testing, especially for high-risk groups. The study was published Thursday in the medical journal JAMA Otolaryngology — Head & Neck Surgery.
Sullivan said that if people know they are in a higher-risk category — such as if they have had a prior sinus or skull base surgery, or if they have a known skull base defect — they can tell their health-care provider before they get a coronavirus test.
“Maybe that subset of patients … instead of just going through a drive-through testing center, those people should be looked at closer, referred to a higher level of care,” he said.
The study did not provide the results of her coronavirus test.
Sullivan said the woman’s skull base defect was repaired in the operating room and she recovered well from the procedure.
“As far as I know, probably at least a month or two out from that surgery, she’s doing pretty well,” he said.