Question
Hi Mr. Leatherman - I really hope you can help me! Just today, my boyfriend
was bodyboarding and he was driven head first into the sea floor by a wave.
He had some minor bloody scrapes on his forehead and nose and complains
of neck pain behind his head by his spine. When he returned to our towel I
saw a clear fluid drip like a stream from his nose. He's home now resting and
seems coherent and claims he's fine. His eyes are a bit bloodshot and there
have been a few more instances of clear fluid coming out of his nose. I'm
making an appointment for him in the morning - but do you think he needs
more immediate emergency care? He's 45 years old and has already had his
L5 removed...

Thanks again for your help on this!

Kind Regards,
Jess

Answer
Dear Jess,

I don't want to alarm you, but clear fluid leaking from his nose needs to be immediately followed up with.  Although remote, this could be CSF (cerebro-spinal fluid) leaking from the spinal cord.

Due to the mechanism of injury, the basilar part of the skull is susceptible to fracture.  When this occurs the CSF fluid that bathes the brain and spinal cord can leak into the nose or ears, and this is a very serious injury, which can easily result in death.

You should take him to the emergency room and have it checked out immediately. I have seen these fractures before from trauma and often there are no outward injuries to see, however the patient can deteriorate very quickly and die.  

Be safe and get him checked out. Best and most likely scenario is that it is just sea water that was stuck up in the sinus cavity, and a neck sprain, but always rule out the bad first and then progress on.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net