Korean J Neurotrauma.  2013 Oct;9(2):142-145. 10.13004/kjnt.2013.9.2.142.

Delayed Meningitis Complicated by the Frontal Sinus Opening to the Dura Mater in a Patient with Intracranial Injury Fifteen Years Ago

• Shin J
• Oh S
• Chung B
• Rhim J
• Lee C
• Choi J

• KMID: 2156117
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.142

Abstract

Meningitis is the inflammation of the membranes of the brain and spinal cord. This disease is considered life threatening and classified as a medical and emergency. Here we report a case of delayed meningitis occurred in a patient with craniotomy for traumatic brain injury fifteen years ago. Meanwhile, he had been well, however he complained of headache for five days. A brain computed tomographic scan showed air density on the frontal lobe with frontal sinus defect and pansinusitis. His mental state was suddenly changed to stuporous, despite a day of empirical antibiotics. Therefore, a successful cranialization was performed and he was gradually improved. This is a rare case report. Our case shows that surgical intervention is to be considered in some cases of posttraumatic meningitis for effective and rapid control of infection.

Keyword

Basal skull fracture; Cranialization; Meningitis

MeSH Terms

Anti-Bacterial Agents
Brain
Brain Injuries
Craniotomy
Dura Mater*
Emergencies
Frontal Lobe
Frontal Sinus*
Headache
Humans
Inflammation
Membranes
Meningitis*
Spinal Cord
Stupor
Anti-Bacterial Agents

Figure

• 

  FIGURE 1. Axial and coronal brain CT scan showing pneumocephalus with frontal sinus opening to the left frontal lobe.

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  FIGURE 2. Operative photographs demonstrating the cranialization procedure. A: Removal anterior wall of the frontal sinus. B: Removal of the granulated and inflamed wall of the frontal sinus. C: Meticulous extirpation of the frontal sinus mucosa. D: Flapping with the pericranial fascia to close the sinonasal tract. E: Packing the empty cavity with free fat tissue. F: Reconstruction of the anterior wall of the frontal sinus with a Mesh sheet.

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  FIGURE 3. The high power microscopic finding demonstrating abscess formation, predominantly neutrophils (H&E, ×200).

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