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Published on: February 29, 2020

Recurrence of pneumococcal meningitis due to primary spontaneous cerebrospinal fluid fistulas

H Y Wen1, M L Chou, K L Lin

  • 1Division of Pediatric Neurology, Chang Gung Children's Hospital, Taipei, ROC.

Chang Gung Medical Journal
|February 1, 2002
PubMed

Insights

Recurrent pneumococcal meningitis in a child was successfully treated after surgery to repair spontaneous cerebrospinal fluid (CSF) fistulas. This case highlights the importance of investigating anatomical defects in recurrent meningitis without immune deficiencies.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Recurrent bacterial meningitis can stem from various causes, including immune deficiencies and anatomical abnormalities.
  • Spontaneous cerebrospinal fluid (CSF) fistulas are rare but critical causes of recurrent meningitis, often presenting without a clear history of trauma or surgery.

Observation:

  • A Taiwanese boy experienced three episodes of pneumococcal meningitis between ages 2 and 6 years 10 months.
  • Extensive investigations, including imaging and immunological studies, initially failed to identify the cause of recurrent meningitis.
  • Technetium-99m diethylenetriamine pentaacetic acid (Tc-99m-DTPA) radionuclide cisternography identified abnormal CSF leakage over the right mastoid area.

Findings:

  • Primary spontaneous CSF fistulas were diagnosed as the underlying etiology for recurrent pneumococcal meningitis.
  • Neurosurgical intervention to seal a dural tear and pack a petrosal fissure successfully resolved the CSF leak and prevented further meningitis episodes.

Implications:

  • This case underscores the necessity of evaluating for underlying anatomical defects, particularly spontaneous CSF fistulas, in patients with recurrent bacterial meningitis, even in the absence of immune deficiencies.
  • Early and accurate diagnosis of CSF fistulas through advanced imaging techniques like radionuclide cisternography is crucial for effective surgical management and prevention of severe neurological complications.

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