BMJ Case Reports 2012; doi:10.1136/bcr-2012-006749
  • Unusual presentation of more common disease/injury

Not the usual sinusitis

  1. Ragai Fouda3
  1. 1Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
  2. 2University of Texas Health Science Center, Houston, Texas, USA
  3. 3Internal Medicine, Cairo University School of Medicine, Cairo, Egypt
  1. Correspondence to Dr Hussam Ammar, hussam.m.ammar{at}


An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull. It is a rare cause of seizure in adults. A 38-year-old woman presented with a first-onset seizure. Brain CT was interpreted as right frontal sinus opacification suggestive of sinusitis. The patient was discharged home with an amoxicillin prescription. A few days later, she was re-admitted with another seizure. Careful evaluation of the brain CT and MRI revealed a right frontal sinus posterior wall defect and possible brain encephalocele. The patient had complained of chronic nasal discharge for years and had also noticed a watery discharge from her right nostril. We suspected cerebrospinal fluid rhinorrhea. A bifrontal craniotomy was performed, the encephalocele was resected and cranialisation of the frontal sinus was completed. The patient remained free of seizures at the last follow-up.

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