Male with watery rhinorrhoea and disturbed consciousness after trauma

Hachisu T, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222288 Description A 74-year-old man presented to the emergency department with slightly impaired consciousness (Glasgow Coma Scale (GCS): E3V5M6) after a fight while drinking alcohol. The next day, he developed a strong headache and gradually deteriorating consciousness (GCS: E3V4M6) with watery rhinorrhoea (see online supplementary video 1). CT showed air between the tips of the frontal lobes, the so-called ‘Mount Fuji sign’, with fractured bone within the anterior skull base 2 days after the trauma (figure 1A,B). The patient was admitted to the operating room for endoscopic reconstruction of the fractured area of the posterior wall of the frontal sinus (figure 2, white star). Withered brain parenchyma (figure 3, white dot) and a cerebral vein, (figure 3, white arrow) were seen with the endoscope (see online supplementary video 2) and reconstructed with fat and fascia from the thigh covered with bilateral inferior turbinate flap.The patient made