Failure to Thrive Related to Nasal Encephalocele in a Toddler: A Diagnostic Challenge

Infants with an extremely low birth weight, who receive intensive unit care in the neonatal period may have severe unrecognized neurologic sequelae. We describe a 3-year-old boy, born preterm small for gestational age, who presented with food aversion, failure to thrive, and recurrent upper respiratory tract infections. Because of persistent rhinorrhea, nasal endoscopy was performed revealing a gray polypoid mass in the right nasal cavity. β-trace protein concentration in the nasal secretions confirmed cerebrospinal fluid (CSF) leakage. Magnetic resonance imaging showed perforation of the lamina cribrosa with a large nasal encephalocele. The clinical presentation of growth retardation, recurrent infections, hyponatremia, and hypoalbuminemia could be explained by persistent loss of CSF. Following surgical correction of the defect, gradual recovery of the overall condition, including catch-up growth occurred. Reconstruction of perinatal care in this patient revealed complicated nasotracheal intubation immediately after birth, providing an adequate explanation for an acquired perforation of the lamina cribrosa.