| Identifier |
walsh_2019_s3_c6-slides |
| Title |
Turbulence, Fluid Waves, and the Black Hole |
| Creator |
Stella Y. Chung, MD, MS |
| Subject |
Eyelids; MRI; Skull Base |
| History |
A 61-year old male developed an acute exacerbation superimposed on a 3-month relapsing and remitting course of painless eyelid swelling beginning in the right upper lid progressing to involve both upper and lower eyelids, malar area, and temporalis. He provided photographic documentation of dramatic waxing and waning course, sometimes preventing him from opening his eyelids (Figure 1). His condition was poorly responsive to repetitive courses of antibiotics and corticosteroids, but showed mild improvement with compressive dressing. The patient denied a pulse synchronous bruit. However, when questioned about auditory symptoms, he described a "rushing fluid" sound when he digitally compressed the eyelid tissues. He denied previous trauma or surgery. He worked as a truck driver and had strong inclination to "selfies", providing ample documentation of his waxing and waning course of eyelid edema. Examination showed severe right upper and lower eyelid demarcation extending to the malar and temporalis areas, without tenderness, erythema, or proptosis. The remainder of the slit lamp and funduscopic examinations were normal. CT orbit obtained prior to presentation reported "significant right periorbital swelling without other abnormalities' but images were unavailable. T1 orbital fat suppressed contrast enhanced axial and coronal imaging and T2 axial and FLAIR images demonstrated diffuse enhancement and enhancing collection of the fluid in the right upper eyelid, malar, and temporalis regions on T1 sequences (Figure 2A and 2B) that were bright on T2 (Figure 2C) and demonstrated signal suppression on FLAIR (Figure 2D). Radiology report summarized the findings as "large phlegmon or abscess overlying the orbit without post-septal involvement." CBC with differential, urinalysis, HIV, and blood culture were normal. A biopsy was performed for intra-operative study to confirm the diagnosis. |
| Disease/Diagnosis |
Non-traumatic CSF blepharocele. Blepharocele results from an intermittent accumulation of CSF in eyelid tissues secondary to a cranio-orbital fistula between the subarachnoid space and the eyelid.1 Cranio-orbital fistulas are uncommon complications associated with cranio-orbital trauma and surgery. As orbital pressure is typically higher than that in the nose or ear, rhinorrhea and otorrhea are the most common manifestations of CSF leakage, while CSF accumulation in the eyelid and orbit rarely occurs. Beta 2-transferrin is a protein found exclusively in CSF and perilymph, tested extensively in skull base and spinal surgeries for detection of CSF with a sensitivity of 94 to 100% and specificity of 98 to100%.3 The diagnosis of non-traumatic CSF blepharocele was supported by critical review of neuroimaging. MRI FLAIR studies appeared to follow the characteristics of CSF, and CT studies revealed an area of bony dehiscence after Beta-2 transferrin confirmation of CSF in tissue. A craniotomy directly identified the site of CSF fistula, which was successfully repaired. |
| Date |
2019-03 |
| References |
1. Chandra N, Ojha BK, Chandwani V, Srivastava C, Singh SK, Chandra A. A rare case of posttraumatic eyelid swelling: cerebrospinal fluid blepharocele. J Neurosurg Pediatr. 2013; 11(3):242-4. 2. Germano R, Silva M, Germano F, Brandao M, Germano C, de Souza B, Kawai R, Germano J. Eyelid liquoric fistula secondary to orbital meningocele. Revista Brasiliera de Oftalmologica. 2015; 74(1). |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
2019 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting 2019: Frank B. Walsh Session 3 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6007 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6np6nmh |
| Setname |
ehsl_novel_fbw |
| ID |
1431992 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6np6nmh |
