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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes concussions followed by heavy sinus drainage immediately?

Answered by
Dr.
Dr. Abubakar Siddiqh

ENT Specialist

Practicing since :1994

Answered : 2038 Questions

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Posted on Mon, 8 Aug 2016 in Ear, Nose and Throat Problems
Question: My son has a history of concussions from football. He can get concussion symptoms just by lifting to much weight, hitting a big bump in his car, or coughing too hard. His brain is sensitive for days to weeks after this happens.

The most concerning issue, though, is that when he suffers one of the above traumas to his brain, his sinuses almost immediately drain and do so heavily. It is not sinus fluid being drained by a blow as it happens just by lifting heavy weights. It's almost like his brain fluid is coming out (it is usually clear fluid but occasionally brownish). Should we be concerned? What is the cause of this?
doctor
Answered by Dr. Abubakar Siddiqh 6 hours later
Brief Answer:
Seems to be Vado motor rhinitis

Detailed Answer:
Hi,

I had gone through your question and understand your concerns that your son is having fluid from nose. I would like to ask you few more details.

Is there any episodes of sneezes or nasal blockage?
Is there any head-ache or loss of consciousness or fits episodes ?

Based on your clinical details, it appears to be csf rhinorrhea or vasomotor rhinitis.

I suggest you to do MRI brain with CT cisternography to rule out the cause and site of leak.

Kindly discuss with your treating doctor about this investigations.

Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health.




Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Abubakar Siddiqh 44 hours later
Thank you for your reply.

Answers to your questions: No sneezes or nasal blockages; Yes to headaches. He feels pressure in his brain after a trauma and is slightly disoriented for days to weeks at a time.

He lifted too heavy a weight last week. He sort of felt a "pop" in the sinus area next to his nose (this pop has happened each time he has hurt his brain over the last five years), but he feels it an inch inside, like it is in the skull. Within a day, if he bends over, his sinuses drain a LOT of white fluid.

?? How can a trauma to the brain (concussion) end up increasing his sinus pressure (his face hurts) and leaking sinus fluid? Is there a space in the skull between the brain and the sinus system that he could have damaged/weakened? That might be the question to be answered.

He has had several MRIs and CTs over the years. The last one found a small cyst in the sinuses that the doctors were not concerned about. Thanks in advance for your reply!
doctor
Answered by Dr. Abubakar Siddiqh 4 hours later
Brief Answer:
vasomotor rhinitis.

Detailed Answer:


Hello again,

Thanks for considering my answer and for your follow up.


Answers for your queries.

1. Repeated MRIs and CT scan concludes, there is no brain or brain related pathology.

2. Yes. Trauma can induce sinusitis ( traumatic injury causes bleeding and blockage of XXXXXXX ency of sinus pathways, where blocked sinuses can lead to sinusitis.

Commonest area of damage (cribriform plate) of skull which separates sinus cavity from brain, can be damaged with trauma (skull fracture or any surgical procedure (pituitary).

3. In my opinion, it's a simple sinusitis with vasomotor rhinitis. There is no brain pathology, as there is no evidence of weekend or damaged bone by investigations.

All his symptoms are due to vasomotor rhinitis. Draining fluids from nasal cavity are normal nasal secretions (in case of suspicion, send his sinus secretions for lab tests (beta 2 transferrin levels are more in cerebro spinal fluid, when compared with nasal secretions) to differentiate from brain fluids).

4. Small cysts of sinuses, will not have any clinical significance. Ask him to stop lifting the weights and avoid heavy strenuous exercises.

4. I suggest you to start nasal spray (Astelin Nasal Spray (azelistine) 2 sprays per nostril twice a day (you need a prescription from a local doctor).

Kindly discuss with your treating doctor, for lab tests and treatment options.

All the best. Take care.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Abubakar Siddiqh 45 hours later
You nailed it on your first reply! I looked up why you suggested "CT cisternography to rule out the cause and site of leak." This led me to research this and found several sites that suggest with 99% certainty that he has Cerebral Spinal Fluid leak in the sinus area.

We looked at the dozen or so symptoms of a CSF leak and he had ALL but one. Every incident he has had with brain trauma followed by drainage and all other symptoms is perfectly explained by this diagnosis. The most curious was his lethargy and tiredness after an incident -- one lasted months a few years ago -- and this is common with the CSF leak. And it also explains why his many doctors said that there was nothing wrong with his brain!

I want you to know that over the last five years my son has been to two neurologists, three ENTs, a cardiologist, and four GPs with numerous CTs and MRIs and none of them diagnosed this. Not one. And none got close to the diagnosis. You found it!

We are headed to a local ENT to get a referral to see if we can get up to Cedar Sinai Hospital in New York City where they treat the leak site through endoscopy, one or two day hospital stay at most! 98% success rate, 1% negative side effect rate!

I can't thank you enough for figuring this out. After five years of on and off headaches, tiredness, etc. after a trauma to his brain, he now has a solution. I will write you up the best review you have ever received! And you deserve it. THANK YOU, THANK YOU, THANK YOU. You will have changed my son's life.

Sean XXXXXXX


doctor
Answered by Dr. Abubakar Siddiqh 1 hour later
Brief Answer:
most welcome.

Detailed Answer:

Hello again,

You are most welcome.

God bless you.

All the best. Take care.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
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