Post-COVID Nasal Swab Pain: Is Cerebrospinal Fluid Leakage Possible?

Q: Post-COVID Nasal Swab Pain: Is Cerebrospinal Fluid Leakage Possible?

Hello： It is less likely for a cotton swab to be inserted into the left nostril. <br>However, if there is a persistent sensation of clear fluid flowing into the throat, along with symptoms such as headache and fever, it is advisable to visit a hospital for a blood test to check f

I experienced severe discomfort after performing a COVID-19 rapid test on my left nostril, and my left nostril has been continuously running clear fluid?

Hello Doctor: I underwent a COVID-19 rapid test at the hospital at 10 AM.
When the swab was inserted into my left nostril, I experienced extreme pain, with facial nerve tension causing my eyes and mouth to scrunch up, and a severe tingling sensation deep in my nose.
Afterwards, I felt dizzy, with blurred vision, and it was difficult to stand, but I managed to complete the test.
After returning home, the pain and tingling in the deep part of my nose persisted until midnight before I went to bed, and my left nostril kept running clear fluid, which was not much but continuous, unlike mucus, as it had no odor and was completely transparent.
I also experienced abdominal cramps.
The next day, the tingling in my left face around the eye and mouth slightly subsided, but I continued to feel dull and different than usual, with the deep pain still present but reduced.
The amount of fluid decreased, and by the third day, I felt a wet sensation deep in my left nostril, with no fluid discharge, and a slight swelling and warmth in my head.
I visited an ENT clinic, where the doctor used an endoscope to examine my nasal cavity and found a red spot in the upper area of the nasal cavity (not in the parallel area), and prescribed me pain relief and anti-inflammatory medication.
Today is the fourth day, and I still feel swelling and warmth on the left side of my head, but there is no clear fluid discharge anymore.
Is there a possibility that cerebrospinal fluid was leaking in the past few days? While it is difficult for the swab to cause a wound, could the forceful insertion have pushed the swab close to the base of the skull, potentially causing cerebrospinal fluid leakage? Will it heal on its own? If further examination is needed, what tests should I undergo? Thank you, Doctor.

Guo Sheng, 30~39 year old female. Ask Date: 2021/11/21

Dr. Zhao Shaoqing reply Neurosurgery

Hello: It is less likely for a cotton swab to be inserted into the left nostril.
However, if there is a persistent sensation of clear fluid flowing into the throat, along with symptoms such as headache and fever, it is advisable to visit a hospital for a blood test to check for any signs of inflammation, or to arrange for a CT scan of the brain.
The Changhua Hospital of the Ministry of Health and Welfare is here to assist you.

Reply Date: 2021/11/21

More Info

It sounds like you've experienced a very concerning and uncomfortable situation following your COVID-19 nasal swab test. The symptoms you've described, including severe pain, facial nerve sensations, and clear nasal discharge, raise important questions about potential complications, including the possibility of cerebrospinal fluid (CSF) leakage.

First, let's address the concern about CSF leakage. Cerebrospinal fluid is the clear fluid that surrounds the brain and spinal cord, providing cushioning and protection. A CSF leak can occur if there is a tear or hole in the membranes surrounding the brain or spinal cord, which can happen due to trauma, surgery, or certain medical conditions. In your case, while it is theoretically possible for a nasal swab to cause a CSF leak, it is quite rare. The nasal cavity is anatomically separated from the cranial cavity by the cribriform plate, a thin bone that can be damaged in severe trauma but is generally not affected by a standard nasal swab.

The symptoms you experienced, such as severe pain and the sensation of clear fluid draining from your nose, could be indicative of several conditions. The clear fluid you described could be cerebrospinal fluid, but it is more likely to be a result of nasal irritation or inflammation, especially considering the pain and discomfort you felt during the swab. The fact that the fluid was clear and odorless is also consistent with nasal drainage rather than CSF, which typically has a different consistency and may have a distinct taste or odor if it were leaking.

Your follow-up visit to the ENT specialist, who noted a red spot in the nasal cavity and prescribed pain relief and anti-inflammatory medication, suggests that there may have been some localized trauma or irritation from the swab. The reduction in symptoms over the following days is a positive sign, indicating that your body is likely healing from this irritation.

As for the potential for self-recovery, many minor nasal injuries can heal on their own without the need for invasive treatment. However, if you continue to experience symptoms such as persistent headaches, changes in vision, or any new neurological symptoms, it would be prudent to seek further evaluation. In such cases, imaging studies like a CT scan of the head may be warranted to rule out any complications, including a CSF leak or sinusitis.

In summary, while the possibility of a CSF leak exists, it is relatively low in the context of a nasal swab. Your symptoms are more likely related to irritation or inflammation of the nasal mucosa. Monitoring your symptoms and consulting with a healthcare provider if they persist or worsen is the best course of action. If you have any further concerns, especially regarding neurological symptoms, do not hesitate to seek immediate medical attention.

Similar Q&A

Could a Brain Tumor Cause Nasal Pressure and Discomfort?

Since November of last year, I have been experiencing a feeling of pressure and tightness in my nasal cavity and bridge of the nose. I have seen an otolaryngologist who ruled out nasal issues. I would like to ask if it is possible that this could be caused by a brain tumor pressi...

Dr. Jiang Junyi reply Neurology
Dear Mr. Yan, You mentioned that you have been experiencing a feeling of pressure and tightness in your nasal cavity and bridge of the nose. After consulting an otolaryngologist, nasal issues have been ruled out, and you are inquiring whether it could be due to a brain tumor pre...

Is Clear Nasal Discharge After Exercise Cerebrospinal Fluid?

I just finished running 800 meters in gym class, and my nose has been continuously dripping clear fluid. I initially thought it was just nasal mucus, but it keeps flowing... (I currently do not have a cold). I remembered an email from the past that mentioned this could possibly b...

Dr. Huang Jianling reply Family Medicine
A fracture at the base of the skull can cause cerebrospinal fluid to continuously leak through the rupture into the nasal cavity, resulting in a persistent bloody or clear fluid discharge, which is medically referred to as cerebrospinal fluid rhinorrhea. Generally, physical activ...

Understanding Post-Fall Symptoms: Is It Sinusitis or Something More?

Hello, Dr. Peng. I accidentally slipped and fell at 5 PM the day before yesterday, hitting the back of my head without being able to protect it. The next morning, I started to have phlegm. I found online that others who experienced similar head trauma also had phlegm without any ...

Dr. Peng Xianwen reply Surgery
Hello Ms. Chen: Based on your condition, it seems more like sinusitis. Nasal tissue fluid would only occur in the case of a skull base fracture. Director Peng Hsien-Wen, General Surgery, Nantou Hospital.

Post-Surgery Concerns: Can Ventriculoperitoneal Shunt Cause Cerebrospinal Fluid Leakage?

I would like to ask the doctor about an issue related to a car accident I had in March of this year, which resulted in intracranial hemorrhage. I underwent a ventriculoperitoneal shunt surgery, but since the surgery, I have been yawning frequently—not due to lack of sleep, but ra...

Dr. Zhang Junwei reply Neurosurgery
Drainage surgery is not indicated, but there may be a possibility of cerebrospinal fluid leakage due to previous trauma. Please schedule an appointment with the neurosurgery clinic.