Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics

Cerebrospinal fluid (CSF) leakage following head trauma is often difficult to diagnose, but is of considerable importance in view of the possibility of fistula formation and meningitis. It is unclear whether specific clinical or radiological signs point to an increased risk of CSF leakage. Previous studies have been largely anecdotal and uncontrolled, leading us to perform a retrospective control study comparing the clinical and radiological features of patients with overt CSF leakage, and those without. Of the 293 patients studied, 115 had clinical CSF leakage and 170 did not, with incomplete documentation in eight patients. The group with CSF rhinorrhoea had significantly greater incidence of periorbital haematoma (chi square = 8.642). This suggests that patients with head injuries and features of periorbital haematoma are at greater risk of unobserved dural tear and delayed CSF leakage. Frontal and ethmoid fractures in particular were also associated with CSF leakage (chi square = 5.46). The use of prophylactic antibiotics was studied. There was a significantly greater incidence of meningitis in the group which received prophylactic antibiotics (p = 0.024). There was no significant difference in the incidence of meningitis in those patients with CSF fistulae treated by surgical or conservative methods.