Cerebrospinal fluid leakage-associated bacterial meningitis diagnosed by evaluating glucose concentration in nasal discharge and cerebrospinal fluid: A two-case series.
Daisuke Kudo, Masaki Fujino, Jun Karakama et al.
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Case in brief
Two patients with bacterial meningitis were evaluated for possible cerebrospinal fluid (CSF) leakage. Nasal discharge glucose was elevated and closely matched CSF glucose in both: 55 mg/dL versus 54 mg/dL in one case, and 64 mg/dL in the other. These results suggested CSF rhinorrhea, which detailed imaging or nasal endoscopy subsequently confirmed.
What made this case unusual
In both cases, nasal discharge glucose was nearly identical to the measured CSF glucose, providing a clue to CSF rhinorrhea despite the known limitations of nasal glucose testing.
Diagnostic / clinical pearl
In bacterial meningitis with suspected CSF rhinorrhea, comparing glucose in nasal discharge with CSF may provide complementary information; confirmation in these cases required detailed imaging or nasal endoscopy.
Why it matters
Identifying CSF leakage is important because it can contribute to bacterial meningitis and may inform whether surgical repair is needed to prevent recurrence.