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Open Access Case report

Clival chordoma with an atypical presentation: a case report

Jaber Alshammari1, Philippe Monnier1, Roy T Daniel2 and Kishore Sandu13*

Author Affiliations

1 Department of Otorhinolaryngology, University Hospital - CHUV, Lausanne, Switzerland

2 Department of Neurosurgery, University Hospital - CHUV, Lausanne, Switzerland

3 Department of Otorhinolaryngology, Valais State Hospital - CHCV, Sion, Switzerland

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Journal of Medical Case Reports 2012, 6:410  doi:10.1186/1752-1947-6-410

Published: 29 November 2012

Abstract

Introduction

Clival chordomas present with headache, commonly VI cranial nerve palsy or sometimes with lower cranial nerve involvement. Very rarely, they present with cerebrospinal fluid rhinorrhoea due to an underlying chordoma-induced skull base erosion.

Case presentation

A 60-year old Caucasian woman presented with meningitis secondary to cerebrospinal fluid rhinorrhoea. At first, radiological imaging did not reveal a tumoral condition, though intraoperative exploration and tissue histology revealed a chordoma which eroded her clivus and had a transdural extension.

Conclusion

Patients who present with meningitis and cerebrospinal fluid rhinorrhoea could have an underlying erosive lesion which can sometimes be missed on initial radiological examination. Surgical exploration allows collecting suspicious tissue for histological diagnosis which is important for the actual treatment. A revision endoscopic excision of a clival chordoma is challenging and has been highlighted in this report.