Clinical Practice and Cases in Emergency Medicine

Case Presentation: A 64-year-old Black female presented to the emergency department following a new-onset tonic-clonic seizure. The patient had been given 2 milligrams of lorazepam by emergency medical services with cessation of seizure activity. On physical exam she was lethargic and had clear discharge from the right nare. Computed tomography of the brain initially demonstrated findings consistent with sinusitis versus ethmoidal mass. Magnetic resonance imaging of the brain demonstrated a right frontal ethmoidal encephalocele.

Discussion: Basal encephaloceles occur due to a defect in the skull base. Location of the defect and extracranial herniation of brain tissue can cause neurologic sequelae. This case illustrates the importance of maintaining a broad differential diagnosis and for emergency physicians to obtain imaging when evaluating seizures and/or chronic rhinorrhea in adults.