CSF Leak- A rare cause of clear discharge from Neck wound

Abstract

Background: Traumatic cerebrospinal fluid (CSF) leakage through an external cervical wound is a rare clinical presentation, particularly in the absence of classical symptoms. Early recognition and accurate diagnosis are essential to prevent potentially serious complications.

Case Presentation: A 45-year-old male presented following a road traffic accident involving blunt trauma to the right side of the neck caused by a motorcycle handle. Clinical examination revealed a sutured lacerated wound measuring 7 × 1 cm with diffuse cervical swelling. Initially, serosanguineous discharge was observed for two days, followed by persistent clear, watery discharge without other significant symptoms. Salivary and chylous leakage were initially considered. Routine laboratory investigations were within normal limits. Magnetic resonance imaging (MRI) demonstrated spinal cord edema at C5–C6 and a prevertebral fluid collection extending from the skull base to C7. Fluid analysis revealed increased glucose levels, raising suspicion of CSF leakage. Computed tomography (CT) cisternography confirmed a 2 × 2.1 mm dural tear at the right C5–C6 neural foramen with intrathecal contrast extravasation, associated with minimally displaced fractures of C5, C6 and C7.

Conclusion: Persistent clear discharge following cervical trauma should raise suspicion of CSF leakage, even without classical symptoms. CT cisternography is valuable for confirming dural injury, while early diagnosis and individualized multidisciplinary management may help prevent complications.