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Background
Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause. Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization with many invasive investiga...
Citations
... Рекурентните епизоди на пневмококов менингит в детска възраст са рядко явление и трябва да се подозира подлежаща имунологична или анатомична причина. Анатомична причина е наличието на цереброспинална фистула, причиняваща ликворея [27]. Анатомичната или функционална аспления е доказан рисков фактор. ...
Bacterial meningitis is an acute purulent inflammation of the meninges and subarachnoid space. It is a life-threatening and always urgent condition. Streptococcus pneumoniae remains the most common etiological cause of bacterial meningitis in the world even after the introduction of conjugated pneumococcal vaccines in childhood. In this review article we present literature data on the etiology, epidemiology, pathogenesis, clinical presention, complications, outcome, treatment and prevention of central nervous system infections caused by Streptococcus pneumoniae. The severe course with frequent complications, serious prognosis, as well as difficult treatment and problems with vaccine prophylaxis, determine the high health and social importance of pneumococcal meningitis and meningoencephalitis.
... 9 Li y colaboradores informaron un caso de meningitis neumocócica recurrente de serotipo 23F en un niño con pérdida de LCR luego de haber recibido la vacunación completa de VNC13. 14 Se pueden utilizar diferentes técnicas para detectar o localizar fístulas de LCR. La cisternografía tiene una sensibilidad del 92 % y una especificidad del 100 %. ...
... 9 Li et al., reported recurrent pneumococcal meningitis serotype 23F in a child with CSF leakage who was fully vaccinated with PCV13. 14 Different techniques can use for detect of locating CSF fistulas. MR cisternography showed sensitivity of 92 % and specificity of 100 %. ...
Recurrent bacterial meningitis is a very rare phenomenon in children. Skull base fractures and cochlear implant are the important predisposing factors and, Streptococcus pneumoniae is the most frequently isolated agent. Implementation of 13-valent conjugated pneumococcal vaccine (PCV13) has reduced the occurence of invasive pneumococcal diseases. Vaccination breakthrough is typically related to underlying predisposing conditions. Herein, we reported recurrent pneumococcal meningitis in a patient with a cochlear implant who experienced a head trauma after being fully vaccinated with PCV13. The patient experienced three meningitis episodes within one year. S.pneumoniae was determined on CSF culture in the first and third episodes and detected by PCR at the second episode. Neurosurgical intervention was performed after the third meningitis episode, and the patient had no recurrence problems for the following two years. To our knowledge, breakthrough S.pneumoniae serotype 1 meningitis after full PCV13 immunization has not been reported elsewhere in the literature.
Sociedad Argentina de Pediatría.
... By super-imposing the CT and MR data, his team accurately localized the CSF leaks with a sensitivity of 89%. [4,7] CT-cisternography is considered the gold standard examination for evaluation for CSF fistula. In our hospital, a non-contrast HRCT of the skull base in the axial plane is performed first. ...
Cerebrospinal fluid (CSF) leak occurs due to a defect in the dura and skull base. Trauma remains the most common cause of CSF leak; however, a significant number of cases are iatrogenic, and result from a complication of functional endoscopic sinus surgery (FESS). Early diagnosis of CSF leak is of paramount importance to prevent life-threatening complications such as brain abscess and meningitis. Imaging plays a crucial role in the detection and characterization of CSF leaks. Three-dimensional, isotropic, high resolution computed tomography (HRCT) accurately detects the site and size of the bony defect. CT cisternography, though invasive, helps accurately identify the site of CSF leak, especially in the presence of multiple bony defects. Magnetic resonance imaging (MRI) accurately detects CSF leaks and associated complications such as the encephaloceles and meningoceles. In this review, we emphasize the importance and usefulness of 3D T2 DRIVE MR cisternography in localizing CSF leaks. This sequence has the advantages of effective bone and fat suppression, decreased artefacts, faster acquisition times, three-dimensional capability, y and high spatial resolution in addition to providing very bright signal from the CSF. © 2017 Indian Journal of Radiology and Imaging | Published by Wolters Kluwer - Medknow.
Objective: The purpose of this value-based retrospective study was to compare 20 patients with acute bacterial otogenic meningitis to patients with spontaneous cerebrospinal fluid leaks (sCSF) from idiopathic intracranial hypertension (IIHT), assessing demographics including age, sex, body mass index (BMI) and radiographic features. Materials and Method: This study is a retrospective chart and radiographic review, with focus on value-based care, of 20 patients with acute bacterial otogenic meningitis over five years from January 2014 to January 2019, at tertiary hospitals Perth, Western Australia, compared to recently published cohort of 90 patients with sCSF (49). Mann-Whitney U Test was used to compare the differences between the two groups, an alpha value of 0.05 was considered statistically significant. Patients were compared with respect to age, sex, body mass index, clinical exam and radiological investigations. Results: Patients with otogenic meningitis had similar characteristics to sCSF and IIHT, characterised by middle to older age and elevated BMI and non-traumatic skull base temporal bone defects. At risk patients may require ENT assessment and dedicated skull base and temporal bone imaging to exclude skull base or tegmen defects. Conclusions: Retrospective review of 20 acute bacterial meningitic patients, revealed demographics similar to sCSF, including elevated BMI and mid to slightly older age. Value- based care in patients with fluid in middle ear and mastoid is enhanced by ENT evaluation and dedicated skull base and temporal bone imaging to evaluate for bony dehiscence that may necessitate treatment to prevent otogenic meningitis with associated morbidity and mortality.
Objectives
To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae.
Methods
A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl’s fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl’s fissures.
Results
An 11-year-old female was referred for recurrent meningitis. Imaging demonstrated a fistulous connection between the middle ear and IAC diverticulum via the jugular foramen. Specifically, a Hyrtl’s fissure was identified, as well as demineralized bone around the jugular bulb. Obliteration of the fissure was initially performed, and a fistula reformed 4 months later. Multifocal CSF egress in the hypotympanum was identified on re-exploration, and middle ear obliteration with external auditory canal (EAC) overclosure was performed. A systematic review of the literature demonstrated 19 cases of spontaneous congenital perilabyrinthine CSF leaks. In total, 6 cases had multiple sources of CSF leak and 2 had history suggestive of intracranial hypertension. All of these noted cases demonstrated leak recurrence. Middle ear obliteration with EAC overclosure was successful in 4 recalcitrant cases.
Conclusions
Repair of spontaneous congenital perilabyrinthine CSF leaks in cases demonstrating multiple sources of egress or signs of intracranial hypertension should be approached with caution. Middle ear obliteration with EAC overclosure may provide the most definitive management option for these patients, particularly if initial attempt at primary repair is unsuccessful.
