An encephalocele was identified in the right anterior ethmoid cavity ( Figure 2). At the beginning of the procedure, intrathecal fluorescein was infused through a lumbar drain. The patient was admitted to the hospital for endoscopic surgical repair. The 2017 CT diagnosis was paranasal sinus disease but not an encephalocele. Comparing these images to findings on CT performed in 2017 revealed that the encephalocele dated at least to that time ( Figure 1). Computed tomography (CT) and magnetic resonance imaging (MRI) identified a 1.8-cm encephalocele extending through the right ethmoid fovea into the middle meatus and a right sphenoid wing pseudomeningocele. The nasal drainage tested positive for β 2-transferrin. Flexible nasopharyngoscopy revealed a mass in the right anterior middle meatus, but did not identify the source of the fluid. Physical examination revealed clear rhinorrhea from the right side. The patient’s medical history was notable for idiopathic intracranial hypertension and removal of nasal polyps over 20 years before presentation. Shortly after, she developed unilateral rhinorrhea, headache, and vomiting. The patient had recently completed nasal COVID-19 testing for an elective hernia repair. Shared Decision Making and CommunicationĪ woman in her 40s presented with unilateral rhinorrhea, metallic taste, headache, neck stiffness, and photophobia.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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