A case of bacterial meningitis complicated by post-traumatic cerebrospinal fluid rhinorrhea

This paper reports an 11 year old boy with bacterial meningitis accompanied by post-traumatic cerebrospinal fluid (CSF) rhinorrhea. Streptococcus pneumoniae was cultured from CSF. The clinical course was very rapid before admission and his age relatively high for usual bacterial meningitis. Consequently, we examined the cause in detail. Immunological findings were within normal limits. Although routine graphic examinations, such as cranial X-ray photography, horizontal cranial computed tomography (CT) and magnetic resonance imaging, could not demonstrate a bone defect, both coronal thin-section cranial CT scanning and radioactive isotope counting by means of cotton packed into the nasal cavity were useful for detecting CSF rhinorrhea. In a case of atypical meningitis, the past history should be examined with caution and coronal thin-section CT should be performed.