{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:46:12Z","timestamp":1782265572957,"version":"3.54.5"},"reference-count":12,"publisher":"California Digital Library (CDL)","issue":"3","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Cerebrospinal fluid (CSF) leaks are often the result of trauma or recent surgical procedures; however, a subset can develop from non-traumatic etiologies. Cerebrospinal fluid leaks from congenital and spontaneous encephaloceles can be clinically occult and have devastating consequences if undetected for prolonged periods of time.\u00a0This report highlights a unique case of meningitis after CSF leak caused by ruptured congenital meningocele during a routine nasopharyngeal swab.\u00a0 \nCase Report: A 54-year-old female with diagnosed CSF leak presented to the emergency department (ED) with acute onset of severe headache, and neck and back pain. Prior to this presentation, the patient had experienced two months of persistent headache and rhinorrhea since her coronavirus disease 2019 (COVID-19) nasopharyngeal swab. As part of her outpatient workup, an otolaryngology consultation with subsequent beta-2 transferrin testing and magnetic resonance imaging was performed and she was diagnosed with a CSF leak from ruptured congenital meningocele.\u00a0On ED presentation, she was afebrile, but with mild tachycardia, leukocytosis, and meningismus.\u00a0Lumbar puncture revealed acute streptococcal meningitis. This patient\u2019s meningitis developed due to prolonged occult CSF leak after her COVID-19 nasopharyngeal swab ruptured a pre-existing congenital meningocele.\u00a0 \nConclusion: Nasopharyngeal swabs are being performed much more frequently due to the COVID-19 pandemic. All front-line providers should be aware of the potential presence and rupture of congenital meningoceles in patients who have undergone recent nasopharyngeal swab when risk-stratifying for potential CSF leak and meningitis.<\/jats:p>","DOI":"10.5811\/cpcem.2021.5.52232","type":"journal-article","created":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T01:11:33Z","timestamp":1628903493000},"page":"341-344","source":"Crossref","is-referenced-by-count":10,"title":["Case Report: An Intracranial Complication of COVID-19 Nasopharyngeal Swab"],"prefix":"10.5811","volume":"5","author":[{"given":"Alexandria","family":"Holmes","sequence":"first","affiliation":[{"name":"Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryant","family":"Allen","sequence":"additional","affiliation":[{"name":"Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Oh JW, Kim SH, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean J Neurotrauma. 2017;13(2):63-7.","DOI":"10.13004\/kjnt.2017.13.2.63"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Vemuri NV, Karanam LSP, Manchikanti V, et al. Imaging review of cerebrospinal fluid leaks. Indian J Radiol Imaging. 2017;27(4):441-6.","DOI":"10.4103\/ijri.ijri_380_16"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Sharma M, Mally R, Velho V, et al. Spheno-orbital encephalocele: a rare entity. A case report and review of literature. Asian J Neurosurg. 2014;9(2):108-11.","DOI":"10.4103\/1793-5482.136728"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Okano S, Tanaka R, Okayama A, et al. Congenital basal meningoceles with different outcomes: a case series. J Med Case Rep. 2017;11(1):359.","DOI":"10.1186\/s13256-017-1497-7"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Sachdeva S. 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Idiopathic intracranial hypertension presenting as bilateral spontaneous lateral intrasphenoidal and transethmoidal meningoceles: a case report and review of the literature. J Med Case Rep. 2019;13(1):62.","DOI":"10.1186\/s13256-018-1959-6"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Marty FM, Chen K, Verrill KA. How to obtain a nasopharyngeal swab specimen. N Engl J Med. 2020;382(22):e76.","DOI":"10.1056\/nejmvcm2010260"},{"key":"ref10","unstructured":"Daily testing trends in the US - Johns Hopkins. Accessed October 19, 2020. https:\/\/coronavirus.jhu.edu\/testing\/individual-states"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Ratilal BO, Costa J, Pappamikail L, et al. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.","DOI":"10.1002\/14651858.cd004884"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T01:11:40Z","timestamp":1628903500000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/5vw2q86v"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,4]]},"references-count":12,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,8,6]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.5.52232","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"value":"2474-252X","type":"electronic"},{"value":"2474-252X","type":"print"}],"subject":[],"published":{"date-parts":[[2021,8,4]]}}}