ABSTRACT
The nasopharyngeal swab has been used with increased frequency since the beginning of the COVID-19 pandemic. Little has been written in the literature regarding the complications arising from this procedure, as it is generally accepted as safe. In this report, we describe a case in which a young woman sustained a traumatic skull base injury during a nasopharyngeal swab for COVID-19. We then discuss the subsequent treatment and outcome. This case demonstrates the potential for significant complications arising from this widespread procedure and the necessity for awareness of these potential complications. Laryngoscope, 131:1927-1929, 2021.
Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Cerebrospinal Fluid Leak/etiology , Encephalocele/etiology , Skull Base/injuries , Adult , Encephalocele/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Nasopharynx , Skull Base/diagnostic imaging , Skull Base/surgery , Tomography, X-Ray ComputedABSTRACT
We report the case of a 59 year old male who presented with 2 months of persistent rhinorrhoea from left nostril post a nasal swab done for coryzal symptoms at the peak of the COVID-19 pandemic. Beta-2-transferrin confirmed it to be a CSF leak and imaging showed a left middle cranial fossa encephalocele herniating into the sphenoid sinus as the site of the leak post swab. The leak was treated endoscopically. We describe the case history and management of this exceedingly rare complication of nasal swab for respiratory testing.
Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Cerebrospinal Fluid Rhinorrhea/etiology , Nasal Cavity , Encephalocele/etiology , Humans , Male , Middle Aged , Nasal Cavity/virology , SARS-CoV-2ABSTRACT
SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia induced by respiratory failure. We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection. Given the elevated incidence of cerebrovascular complications in patients with COVID-19, it is imperative for clinicians to be aware of the risk of rapidly progressive cerebral edema in patients who develop COVID-19 associated acute respiratory distress syndrome.
Subject(s)
Brain Edema/etiology , Breast Neoplasms/complications , COVID-19/complications , Encephalocele/etiology , Intracranial Hemorrhages/etiology , Stroke/etiology , Aged , Brain Edema/diagnostic imaging , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , COVID-19/diagnosis , Disease Progression , Encephalocele/diagnostic imaging , Female , Humans , Intracranial Hemorrhages/diagnostic imaging , Risk Factors , Stroke/diagnostic imagingABSTRACT
INTRODUCTION: Apnea testing remains essential for the clinical evaluation of brain death determination. In patients who test positive for SARS-CoV-2, disconnecting the patient from the ventilator and introducing high flow oxygen into the endotracheal tube increases the risk for aerosolization of airway secretions and exposure of the examiner. METHODS: Case report of a patient with an intracerebral hemorrhage that evolved to significant cerebral edema and herniation, who underwent apnea test using a method involving a t-piece and an HME filter. RESULTS: Patient successfully pronounced brain dead using a safe method to minimize exposure to SARS-CoV-2. CONCLUSION: At a time where healthcare workers are at high risk of exposure to COVID-19, the above described method is a safe process for apnea testing in declaration of brain death.