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Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

除了要符合质量标准之外,进口商品还必须按中国规定正确标注。
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Always wanted to be an author but not sure where to start? Have you considered self-publishing? Thanks to Amazon, you can. Kindle Direct Publishing allows you to get the word out via e-books, CreateSpacehelps you develop a print edition and ACX is the audio publishing division. I’ve used all three to develop my book.
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有些腐烂的鸡爪竟然出产于1967年,在腥臭扑鼻的处理场里,这些鸡爪经过漂白剂和其它化学物质“清洁”、涨泡、漂白流程之后,便可重新上市出售。
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37岁的总督瑞奇·罗塞略在午夜宣誓后提出了几项用于缓解短期危机的措施。其中包括一项公投的提案将询问投票公民是否同意建州或独立。许多人认为,波多黎各的政治地位产生了长达十年的危机,近年来已促使超过20万波多黎各人逃往美国大陆。
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Targeted poverty alleviation

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中国始终支持一个团结繁荣稳定的欧盟,也支持强大的欧元,支持欧洲一体化进程,因为这有利于经济全球化、世界多极化和文明多样化。我对欧盟的前景是乐观的,我们对中欧关系的发展前景也是看好的。
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In 2010, a 14-month-old child accidentally fell on a chopstick he had playfully placed into his nose. It did, indeed, puncture the roof of his nose and lodge into his brain. Neurosurgeons did successfully remove the chopstick, with little internal damage long term.

The nasal, or nasopharyngeal, swab for Covid-19 is a PCR (polymerase chain reaction) test looking for active infection, and remains the most accurate to date to assess for acutely infected individuals. This in contrast to the antigen, or rapid test, also performed as a nasopharyngeal swab, which is much less accurate, especially if the test result is negative (it has a very high false-negative rate). The antibody test, which is a blood test, is performed to detect evidence of prior infection, not active illness.

A 40-year-old woman in Iowa underwent a nasopharyngeal Covid-19 swab test as part of her preoperative clearance for an elective hernia repair. Soon after, she developed headache, nausea, vomiting, and clear watery drainage from the side of her nose where the swab had been placed. This was not the type of drainage one would get from allergies, a cold, or even a sinus infection. Picture your kitchen sink trickling out water if it’s not fully turned off. That’s what a spinal fluid leak can look like, which is what she had. In addition, the fact that a runny nose is just on one side is often a tip-off of something unusual. As published in the October issue of JAMA Otolaryngology, it turned out that she had had prior nasal polyp surgery two decades ago, as well as a history of disorder called intracranial hypertension, or increased pressure of the fluid surrounding the brain. The combination of these two entities led to a small defect in the bone between the roof of the nose and the brain, and she had developed a pocket of the brain’s lining prolapsing into the nose, known as an encephalocele. The sack of the encephalocele got nicked by the Covid-19 swab.

Radiologic imaging of her brain and sinuses demonstrated a one-inch area where there was no bony roof of her nose. Instead, there was an out-pouching of the brain’s lining, known as an encephalocele, filled with spinal fluid. The pouch got pierced by the swab, and just like piercing a water balloon that’s attached to a faucet, it immediately started leaking clear cerebrospinal fluid. Once this was identified, she underwent surgical repair of the defect in the bone, and the spinal fluid leak was controlled and repaired.

According to Dr. Jarrett Walsh, Assistant Professor of Otolaryngology-Head and Neck Surgery at the University of Iowa, and senior author of this report, “If the swab is introduced at an angle toward the skull base, then any defect in the skull base is potentially put at risk. Correct technique, following the floor of the nose, is exceptionally safe and will not cause skull base trauma.” When asked if he would recommend avoiding nasopharyngeal testing swabs in general, he thinks not: “Nasopharynx swabs, performed correctly, are safe...I think the group of patients that needs to exercise caution in testing are those who have had anterior (nasal) skull base surgery – specifically those who have had reconstruction of the anterior skull base. With missing bone between the nose and the brain, an errant swab could have significant consequences. This is the group that I would encourage considering an alternative testing technique, if it is available.”

When it comes to Covid-19 diagnostic testing, nasopharyngeal swab approach has been shown to be more accurate than oropharyngeal (oral) swab. However, in some cases, especially where a patient has had prior surgeries in the area between the nose and the brain, or prior injuries in that region, physicians will accept oropharyngeal testing for pre-procedure screening.

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