Child with recurrent meningitis: Encephalocele causing anterior cranial fossa defect with CSF rhinorrhoea

V Mayoorathy,S Doluweera

doi:10.4038/jmj.v30i2.26

Abstract

Recurrent meningitis in children is potentially life threatening, causing long term morbidities and psychological trauma to the patient through the repeated hospital admission and multiple invasive investigations. Immune deficiency and bacterial migration along congenital or acquired pathways connecting CSF pathways to external surfaces are the two important aetiologies which should be taken into consideration1. We report a case of a boy who presented with recurrent meningitis due to defect in the anterior cranial fossa ethmoidal air cells.

Highlights

At 10 years he presented with fever, recurrent convulsion and drowsiness
We report a case of a boy who presented with recurrent meningitis due to defect in the anterior cranial fossa ethmoidal air cells
First episode was complicated with left side foot drop, noticed from day 12 of illness and it necessitated further brain imaging

Summary

Introduction

At 10 years he presented with fever, recurrent convulsion and drowsiness. CSF studies suggestive of pyogenic meningitis and CECT brain showed 2×1.8cm cystic lesion in the anterior fossa suggestive of arachidonic cyst. First episode was complicated with left side foot drop, noticed from day 12 of illness and it necessitated further brain imaging. It was managed as post meningoencephalitic UMN foot drop probably due to precentral gyral infarction and it resolved completely with physiotherapy. The last episode of CSF leakage was about 3 weeks before the illness and he was in remission of these symptoms throughout the hospital stay. He has neither head injuries nor recurrent ear infections in the past. Of the aetiology: Pneumococcal or haemophilus suggest cranial dural defect, E-coli or other gram negative bacilli suggest spinal dural defects and albeit it rarely cause recurrent meningitis without recurrent infection in non-CNS sites. (1)

Case report

Discussion