J Clin Neurol.  2008 Mar;4(1):40-44. 10.3988/jcn.2008.4.1.40.

Recurrent Streptococcus Pneumoniae Meningoencephalitis in a Patient With a Transethmoidal eningoencephalocele

• Yang TH
• Jeong SY
• Oh SY
• Shin BS
• Seo MW
• Kim YH
• Jeong SK

• KMID: 2287685
• DOI: http://doi.org/10.3988/jcn.2008.4.1.40

Abstract

We report a case of recurrent Streptococcus Pneumoniae meningoencephalitis with a transethmoidal meningoencephalocele (TEME) but without cerebrospinal fluid (CSF) leakage. A 35-year-old man was admitted with S. pneumoniae meningitis. He had suffered from four episodes of recurrent pneumococcal meningitis during the previous 4 years. A computed tomography scan of the paranasal sinus showed the TEME protruding through a bony defect of the right frontal base. However, the patient did not have symptoms that could be attributable to CSF leakage, and radioisotope cisternography did not identify a leak. Brain magnetic resonance imaging revealed cortical lesions overlying the TEME, and electroencephalography revealed epileptiform discharges in frontal regions. Appropriate antibiotics therapy without steroids was given to improve his condition. The presented case suggests that even in the absence of clinically demonstrable CSF leakage, an occult skullbase defect and its associated meningoencephalocele should be considered in patients with recurrent bacterial meningitis.

Keyword

Recurrent meningitis; Streptococcus Pneumoniae; Transethmoidal meningoencephalocele

MeSH Terms

Adult
Anti-Bacterial Agents
Brain
Electroencephalography
Humans
Magnetic Resonance Imaging
Meningitis
Meningitis, Bacterial
Meningitis, Pneumococcal
Meningoencephalitis
Pneumonia
Steroids
Streptococcus
Streptococcus pneumoniae
Anti-Bacterial Agents
Steroids

Figure

• 

  Figure 1 Coronal (A) and sagittal (B) computed tomography views of the paranasal sinus, showing a bony defect of the right frontal base and a cystic mass lesion protruding into the ethmoid sinus (arrow).

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  Figure 2 Radioisotope cisternography, indicating CSF activity with no leakage at the right frontal base in the 4-hour-delayed image (arrow). RL: Right lateral view.

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  Figure 3 Brain magnetic resonance images. (A) Coronal FLAIR image, showing cerebral tissue herniating into the right ethmoid sinus and a focal encephalomalatic change in the anteroinferior aspect of the right frontal lobe (arrow). (B) Diffusion-weighted image showing the left lateral ventricle filled with small amounts of irregular debris, indicating pyogenic ventriculitis (arrow).

• 

  Figure 4 Electroencephalogram showing spike-and-slow wave complexes with phase reversal in frontal regions (arrow).

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