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Rapidly fatal pneumococcal meningitis following non-penetrating traumatic brain injury

Gustav Strandvik1, Ahmed Shaaban2, Abdelrahman Rawhi Mahmoud Alsaleh3,4

  • 1Trauma Department, Hamad Medical Corporation, Doha, Qatar gustav.strandvik@sky.com.

BMJ Case Reports
|February 20, 2020
PubMed

Insights

This case highlights the need for targeted antibiotic prophylaxis in traumatic brain injury patients with skull fractures and pneumocephalus to prevent severe infections like pneumococcal meningitis.

Area of Science:

  • Neurology
  • Infectious Disease
  • Trauma Surgery

Background:

  • Severe traumatic brain injury (TBI) management often involves broad-spectrum antibiotics.
  • Current guidelines do not universally recommend targeted antibiotic prophylaxis for TBI patients with skull fractures.

Observation:

  • A young man with TBI developed fever within 24 hours, later diagnosed with pneumococcal meningitis.
  • CT scans revealed pneumocephalus and a frontal bone fracture, despite initial normal findings.
  • Brain-stem death occurred 48 hours post-injury without signs of increased intracranial pressure.

Findings:

  • The patient developed severe meningitis despite initial antibiotic coverage.
  • Pneumocephalus and frontal bone fracture were key indicators of potential infection risk.
  • Aggressive, targeted antibiotic prophylaxis may be crucial in specific TBI cases.

Implications:

  • This case suggests current TBI prophylaxis guidelines may be insufficient for patients with specific fracture patterns.
  • Early, targeted antibiotic use in TBI with pneumocephalus and skull fractures could prevent fatal outcomes.
  • Further research is warranted to refine antibiotic prophylaxis strategies in TBI management.
Keywords:
adult intensive caremeningitisneurological injurytrauma CNS/PNS

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