Clear nasal discharge, unilateral, after C RFA

[Timeoutofmind]

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Pt is S/p TON, C3, C4 RF on the left side.

She told me immediately in recovery. She noticed a little bit of clear nasal discharge on that side.

It got much worse at about three in the morning.

Has continued throughout the day.

Has filled up a couple of Kleenexes.

No fevers, chills, severe headaches, balance, problems, blood.

I reviewed images and needle placement very standard and straightforward.

For now, I told her just to keep an eye… I thought maybe increased neurogenic vasomotor rhinitis from alteration of the nerve signals we ablated? I really don’t have any other great explanation…

Any other thoughts?

 

[Timeoutofmind]

Never mind…
After thinking more about it, I think it’s just too high risk for CSF leak based on her symptoms. I’m going to send her to ER.

 

[clubdeac]

Let us know what happens as this sounds crazy if related to procedure.

 

[Agast]

I thought in order to have CSF rhinorrhea the defect has to be on the side facing the nasal passageway - how would your needle placement cause that?

Do the Kleenexes get stiff as they dry? Apparently CSF tissues don’t stiffen since it’s not mucousy.

I had a random persistent runny nose two weeks ago that I didn’t think much of, then did my regular blood work and had an elevated white count. I’m guessing I had COVID and didn’t realize it.

 

[Timeoutofmind]

I talked to the ER Doctor who talked to another ER doc
They were basically just like no way man.

Given the anatomy it’s not CSF.

Didn’t refuse to see her or anything but just said it would be a wasted visit.

I asked her that thing about the tissues, getting stiff or not, but she was just too vague and couldn’t say either way…

So I told her to just keep me posted for now.

 

[mdo1738]

she was just too vague and couldn’t say either way…

That’s also my go-to move when I have no idea about something

 

[jsaul]

Covid

 

[GoBeers]

there is no way a cervical RFA caused these symptoms lol

 

[buddababa]

Never mind…
After thinking more about it, I think it’s just too high risk for CSF leak based on her symptoms. I’m going to send her to ER.

No way it’s a csf leak. 100% impossible your procedure caused this.

 

[kstarm]

Did she have sedation and a nasal canula with O2? sometimes people can react to that

 

[Timeoutofmind]

Did she have sedation and a nasal canula with O2? sometimes people can react to that

Yes, she did. Good point. Like it just dried her nasal passages out and irritated them you mean?

 

[kstarm]

Yes, she did. Good point. Like it just dried her nasal passages out and irritated them you mean?

yes: Post-procedure Rhinitis After Use of Sedatives and Supplemental Nasal Oxygen

 

[TIVAndy]

only if you were trying to do a sphenopalatine ganglion RFA

 

[clubdeac]

only if you were trying to do a sphenopalatine ganglion RF

Have done it…no nasal drainage fortunately

 

[NJPAIN]

If memory of the old Frank Netter based Ciba symposia serves me correctly, you could test for glucose using a urine dipstick to r/o CSF.

 

[lobelsteve]

Beta2 transferrin