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Occult anterior skull base defect without rhinorrhea as a cause of recurrent meningitis

Devrim Bektas1, Refik Caylan, Osman Bahadir

  • 1Department of Otolaryngology, Karadeniz Technical University, School of Medicine, 61040 Trabzon, Turkey. devrimbektas@yahoo.com

Surgical Neurology
|June 26, 2007
PubMed
Abstract

Insights

Recurrent meningitis can occur with hidden skull base defects, even without obvious cerebrospinal fluid (CSF) leakage. Further investigation for bony defects and submucosal CSF is recommended in such cases.

Area of Science:

  • Neurology
  • Neurosurgery
  • Otolaryngology

Background:

  • Recurrent meningitis poses a diagnostic challenge, particularly when classic signs of cerebrospinal fluid (CSF) leakage, such as rhinorrhea, are absent.
  • Identifying occult skull base defects is crucial for managing patients with unexplained recurrent meningitis.

Observation:

  • A case is presented of a 34-year-old female with recurrent meningitis, initially presenting with fever, headache, and neck pain.
  • Despite negative findings on nasal endoscopy and CT scans for rhinorrhea, advanced imaging (CT and MRI) revealed a cribriform plate defect and a submucosal CSF collection.
  • The patient had a history of meningitis following an upper respiratory tract infection four years prior.

Findings:

  • Computerized tomography and magnetic resonance imaging identified a bony defect in the cribriform plate.
  • A submucosal collection of cerebrospinal fluid was detected behind intact nasal septal mucosa.
  • Endoscopic repair of the anterior cranial fossa defect was successfully performed using a composite middle turbinate graft.

Implications:

  • The study suggests that recurrent meningitis may be linked to occult skull base defects, even without apparent rhinorrhea.
  • It highlights the importance of investigating bony dehiscence and submucosal fluid collections in patients with recurrent meningitis, even with negative initial evaluations.
  • This approach can lead to timely diagnosis and effective endoscopic surgical management, preventing further infectious episodes.

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