A coronavirus swab test that was poked up a woman’s nose caused her brain to leak, a newly published report has said.
The article, published on Thursday, October 1, in the journal JAMA Otolaryngology – Head & Neck Surgery, reports that the swab disturbed a mass in the woman's nasal cavity containing cerebrospinal fluid and brain tissue.
The report, researched by specialists at the University of Iowa Hospitals and Clinics in the US, states that the woman, who is in her 40s, had the swab test before an elective hernia surgery.
Afterwards, she developed a runny nose in both nostrils, metallic taste in her mouth, a headache, neck stiffness, and a sensitivity to light, as well as vomiting.
Doctors inserted a scope into the patient's nose to try and figure out what was going on and discovered a mass inside, but it was determined this was not what was causing the fluid leakage.
A CT scan identified a 1.8-centimetre sac-like structure protruding down into the nasal cavity between a breakage in the bone.
This was discovered to be an encephalocele – a term for a condition usually identified in infants, where the bones of the skull do not fuse completely, creating a gap where cerebral fluids and brain tissue can collect in a protruding lump.
Doctors believe the nasal swab damaged this mass within the nose, causing the leakage of cerebrospinal fluid.
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Cerebrospinal fluid (CSF) is a clear fluid found around the brain and spinal cord and helps to protect the brain and spinal cord from injury, and delivers nutrients and removes waste from those systems.
When a CSF leak occurs, it tends to be because something has created a tear or hole in the connective tissue that keeps the CSF surrounding the brain and spine.
If too much fluid leaks out, the brain sags inside the head, putting pressure on parts of the skull and causing headaches, a condition known as spontaneous intracranial hypotension.
When doctors compared their results to a CT scan the patient previously had taken three years prior, in 2017, they found that the encephalocele had existed back then but was misdiagnosed as paranasal sinus disease, or an inflammation of the sinuses.
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The woman also had a medical history of idiopathic intracranial hypertension, which is related to high pressure in the brain due to a buildup of CSF.
And more than 20 years earlier, she had nasal polyps removed, which are soft, noncancerous masses that develop and hang down in the nasal passageway.
They can sometimes impact a person's breathing or encourage infections, and thus may need to be removed.
The real problem — the breakage in the skull itself — had gone undiagnosed for years.
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As soon as the true problem was identified, doctors operated in order to reduce the mass.
To close the hole in the bone that had allowed the sac-like protrusion to form, they used a soft tissue skin graft, which serves as a scaffold for cells to incorporate the graft into the bone.
"To our knowledge, this is the first report of an iatrogenic CSF leak after a nasal swab for Covid-19," the case report stated.
"This patient had an undiagnosed skull base defect at the fovea ethmoidalis that was present on imaging dating back to 2017," the report continued. "We therefore theorise that the swab itself did not result in a violation of the bony skull base, but rather the invasive test caused trauma to the patient's preexisting encephalocele."
The report noted that it is common to screen patients for Covid-19 before they get non-related surgeries, and also that Covid-19 tests with nasal swabs are increasingly common in the United States.
"As the number of daily Covid-19 nasal and nasopharyngeal swab specimen collection procedures increases, a greater burden is placed on the health care system to properly train clinicians and even the general public to safely perform nasal and nasopharyngeal swab testing," the report stated.
They suggested that alternative testing methods than nasal swabs be used for patients with a history of sinus issues or skull base defects.
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