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Blocked and runny nose. Is it related to previous traumatic brain injury? History of acne and hormonal imbalance.

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My husband had a TBI (brain trauma) 4 years ago. He recovered well, but for last few years he has blocked & runny nose and nothing seems to work.I was wondering if it can be related to his brain injury and what should he do.
My husband is 34 years old, height - 195 cm , weight - 85kg.He had a motorbike accident which caused enclosed traumatic brain injury. After almost 3 weeks in induced coma he actually made a remarkable recovery. For almost 3 years after the accident he had severe acne and hormone imbalance, but now it's all back to normal.
Thank you
Posted Sun, 22 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 19 hours later

Thank you for your query.

It is good to hear that XXXXXXX made an excellent recovery. Hormonal imbalance after traumatic brain injury is due to transient damage to the pituitary gland and the hypothalamus.

His symptoms of nasal blockage and nasal discharge may be due to:

1. Damage to the autonomous nervous system, though the exact mechanism is unknown. This leads to vasomotor or intrinsic rhinitis because the nose has a XXXXXXX autonomic nerve supply.
2. CerebroSpinal Fluid (CSF) leak through the anterior or middle cranial fossa.
3. Fractures at the time of the trauma altering the nasal and sinus structure, thereby altering airflow and leading to changes in the nasal lining (mucosa).

I recommend the following investigations:

1. Collect the nasal secretions if possible / sufficient and get an examination to rule out a CSF leak. A Beta-2 Transferrin test will be ideal , if it is available.

Is there any particular head position when nasal discharge increases (Tea-Pot or Reservoir Sign)? Does a handkerchief stiffen with the nasal discharge or not?
Was there any Halo Sign ever noticed on a handkerchief after the trauma?

2. A plain CT PNS (Para Nasal Sinuses) with 1 mm coronal, axial and sagittal cuts on a multi-slice machine with a planned contrast study and a cisternogram if CSF leak is suspected.

3. A trial with a combination of an anti-histaminic (such as levocetrizine, rupatidine or fexofenadine) and an anti-leukotriene such as montelukast or zileuton), along with a steroid nasal spray, steam inhalation and saline nasal washes.

4. Routine Blood investigations including an Absolute Eosinophil count (AEC).

I would be able to give you more information, if you could share with me the result of the aforementioned test (if they are already done). You may load the reports here or send them to my attention at YYYY@YYYY . You may share the reports via a free file sharing site such as WWW.WWWW.WW
Awaiting your reply.

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