A US woman who underwent a COVID-19 nasal swab test got her brain’s lining punctured, causing fluid to leak from her nose, according to a case reported in a medical journal on Thursday. The doctors reported this incident was a life-threatening risk of infections for the woman.
The woman, who is in her 40s, had an undiagnosed rare condition and the test she received might have been carried out improperly. Though, a sequence of improbable events means the risk from nasal tests remains very low.
Jarrett Walsh, senior author of the paper that appeared in JAMA Otolaryngology-Head & Neck Surgery said, “particularly her case showed that health care professionals should take proper measures and must follow proper testing protocols closely.”
People who’ve had extensive sinus or skull base surgery should consider requesting oral testing if available, he added.
Dr. Suresh Naruka, ENT specialist at Apollo Hospitals, New Delhi, talked to Healthwire and explained, “The roof of nose is connected to the brain with a layer of thin bone which separates the nose from the brain is known as the base skull, and if someone tries to push it harsh during the swab test then it may increase the chance of the bone to break. So, incidents like this can occur if the base skull is weak or thin. Some patients might have a defect in the base skull or nasal cavity, and if the test is not done properly or by mistakenly the stick goes inside the brain through the defect, can rupture the brain layers and fluid can come out.”
“Therefore especially patients with nasal cavity or any other defect must be very careful while going for a swab test. These tests should be conducted under a proper guidance of the specialist or ENT’s and if required they should get a CT scan done before the test of such patients. The children and the older patients are at risk of these incidents as they have weak and thin base skull. So strict safety measures should be taken while the nasal swab tests are conducted because there can be a life-threatening risk of brain infection from bacteria that can travel up the nose”, said doctor Naruka.
The ear, nose, and throat specialist Dennis Kraus of Lenox Hill Hospital in New York, who wasn’t involved in the paper said, “It underscores the necessity of adequate training of those performing the test and the need for vigilance after the test has been performed.”
Walsh, who practices at the University of Iowa Hospital, said the woman had gone for a nasal test ahead of elective hernia surgery, and afterward noticed clear fluid coming out of one side of her nose. She subsequently developed a headache, vomiting, neck stiffness, and aversion to light, and was transferred to Walsh’s care. And the Doctors at that time used a shunt to drain some of the fluid and the condition resolved.
“She had been swabbed previously for another procedure, same side, no problems at all. She feels like maybe the second swab was not using the best technique and that the entry was a little bit high,” he said.
It caused her to develop an encephalocele, or a defect at the base of the skull which made the brain’s lining protrude into the nose where it was susceptible to rupture.
The woman also had a history of intracranial hypertension — meaning that the pressure from the cerebrospinal fluid that protects and nourishes the brain was too high
This went unnoticed until old scans were reviewed by her new doctors, who carried out surgery to repair the defect in July. She has since fully recovered, according to the doctors.
Walsh said he believes the symptoms she developed were a result of irritation to the lining of the brain. If the problem hadn’t been treated, she could have developed a potentially life-threatening brain infection from bacteria that traveled up the nose. Or, air could have entered the skull and placed excess pressure on the brain.
Most of the testing protocols call for healthcare providers to follow the path of the floor of the nose, which lies above the roof of the mouth, rather than pointing the swab up — or if they point it up, to do so with great care.
Walsh said that though this was likely a very rare occurrence, it was a reminder of the need for high-quality training; given that hundreds of millions of more tests will be performed before the pandemic is over.