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Abstract: A 17-year-old girl was accidentally involved in a car accident while traveling and was admitted to the hospital for examination and diagnosis of skull base fracture with focal brain contusion (left frontal lobe), occipital fracture (right side), and cerebrospinal fluid ear leak. After admission, the patient was given medication. After 3 weeks of careful treatment, the patient’s cerebrospinal fluid ear leakage completely stopped, the discomfort symptoms were basically eliminated, her mental state was good, and she was discharged from the hospital.
Basic information】Female, 17 years old
Disease Type】Skull base fracture
Hospital】Tonglian Group General Hospital
Consultation time】March 2019
Treatment plan】Intravenous medication (snake venom hemagglutinase injection, acetylglutamine injection, sodium chloride injection) + oral medication (loxoprofen sodium)
【Treatment period】Recovery discharge after 3 weeks of treatment, outpatient follow-up after 2 weeks
Treatment effect】Cerebrospinal fluid ear leakage completely stopped, headache, dizziness, nausea and other uncomfortable symptoms relieved, mental status good
I. Initial consultation
The patient was 17 years old and was admitted to the hospital as an emergency due to a serious car accident. The patient was observed to have a swollen scalp with localized abrasions on the right posterior occipital region. The cranial CT bone window showed obvious fracture lines at the base of the skull, and there was a continuous flow of bloody fluid from the external ear canal of the right ear. Comprehensive symptoms, signs, and imaging findings led to the diagnosis of skull base fracture, focal cerebral contusion (left frontal lobe), occipital fracture (right side), and cerebrospinal fluid ear leakage.
II. Treatment history
Given that the patient was a compound injury, the patient was transferred to the intensive care unit for treatment. The patient was observed for consciousness, pupil and limb movement, and changes in vital signs were closely monitored to maintain blood pressure at 120/70 mmHg and blood oxygen saturation at more than 95%. The patient was advised to rest absolutely in bed and to avoid strenuous head activities as much as possible. For cerebrospinal fluid aural leakage caused by skull base fracture, the patient was given health education and told not to do sneezing and violent coughing as much as possible to avoid the increase of intracranial pressure, and was also given snake venom hemagglutinase injection to stop bleeding, acetyl glutamine injection and sodium chloride injection to nourish nerves and rehydration. The patient was also given a three-dimensional reconstruction of the skull base to clarify the extent and severity of the skull base fracture, oral loxoprofen sodium capsule to relieve pain symptoms, and consultation with relevant departments was also requested.
III. Treatment effect
On the morning of the second day of hospitalization, the patient did not see any further outflow of bloody cerebrospinal fluid, and felt some relief from the original headache and dizziness, but still felt mild nausea and dry vomiting. The patient was given a repeat cranial CT, which showed that the extent of the left frontal lobe cerebral contusion had been reduced compared with the previous one, and a repeat chest CT showed traumatic wet lung. Sterile saline was given to enhance nebulization to help dilute sputum and promote sputum excretion. After 3 weeks of treatment, the patient was discharged with no obvious headache, dizziness, nausea, dry vomiting and good mental status, and the review of cranial CT showed that the left frontal lobe cerebral contusion was basically absorbed.
IV. Notes
We are glad that the patient was discharged after a series of treatment. Before discharge, the patient was advised to take more bed rest for a short period of time, avoid premature ground activities, and recuperate at ease. Try not to pull out the ears, come to the hospital when you feel discomfort in the ears, ask the otolaryngologist to observe with an otoscope, and if there is cerebrospinal fluid sediment, it needs to be cleaned up. Try to choose a light diet, low salt and low fat, eat more fresh vegetables and fruits, eat less spicy and stimulating food, don’t stay up late and avoid receiving too much mental stimulation. review the head CT in 2 weeks and observe the changes of the disease.
V. Personal insight
The patient in this case was quite lucky and had a good overall recovery at the time of discharge. When you go out, you must pay attention to traffic safety, pay more attention to the road conditions, and wear a helmet and take protective measures when riding an electric bicycle. In case of traffic accidents, call the emergency number immediately and have the patient transported to the hospital by professional medical personnel.