Intracranial hypotension and recurrent pleural effusion after snow-boarding injury: a manifestation of cerebrospinal fluid-pleural fistula.

Background Data: Intracranial hypotension causing postural headaches has been described after occult and postsurgical cerebrospinal fluid (CSF) leaks and rarely isolated lumbar punctures. The occurrence of a CSF-pleural communication is much rarer, and a high level of suspicion aids in prompt recognition.

Purpose: Early detection and anatomic delineation of the site of CSF-pleural fistula allows prompt intervention, results in resolution of symptoms and prevents the complication of meningitis.

Q fever as a biological weapon.

Q fever is a bacterial zoonosis caused by Coxiella burnetii, a unique intracellular coccobacillus, adapted to live within the phagolysosomes of macrophages and monocytes. It is highly infectious, with as little as one organism needed to cause clinical infection, making it an attractive organism for use in biowarfare. Despite its high infectivity, it has low virulence, and most patients undergo only asymptomatic seroconversion.