1167 RECURRENT BACTERIAL MENINGITIS

Abstract

Seventeen patients with 2 or more episodes of meningitis and no clinically apparent anatomic defect have been referred during the previous 3 years. Predisposing abnormalities were demonstrated in 10 of these cases, 4 anatomic defects and 6 immune deficiencies. One had a fracture of the petrous bone, apparent on routine CT scan. Three other patients had previously been examined with skull and sinus radiographs, routine cranial computed tomography, intrathecal radioisotope tracer studies, and immunologic evaluation. δ11 of these studies were non-diagnostic. Pneumococcal vaccine and prophylactic penicillin therapy were ineffective in preventing recurrent episodes in two cases. We therefore employed a unique method for examining intracranial anatomy, i.e. thin section (2mm) coronal cranial computed tomography which demonstrated anatomic defects in all three patients. The use of metrizamide cisternography was not necessary to diagnose the defects., All had fronto-ethmoidal encephaloceles which were repaired surgically. Direct coronal computed tomography therefore offered a relatively easy noninvasive method for delineating anatomic abnormalities in these patients with recurrent meningitis. Six others had immunologic abnormalities, two with absent C2, one lacked C6, two had common variable hypogammaglobulinemia and one, transient hypogammaglobulinemia of infancy. The evaluation of recurrent meningitis should include Ig, CH100, and a CT scan, using coronal plane thin sections.