Occult anterior skull base defect without rhinorrhea as a cause of recurrent meningitis

Abstract

Background We present a case of recurrent meningitis in a patient with an occult skull base defect and without clinically or radiologically demonstrable rhinorrhea. Case Description A 34-year-old female patient presented with headache, fever, and cervical pain and was diagnosed with acute purulent meningitis. Her medical history revealed another meningitis episode following an upper respiratory tract infection 4 years before. She did not have any rhinorrhea complaint. Nasal endoscopy and computerized tomography with metrizamide failed to demonstrate any subclinical rhinorrhea. However, a bony defect in the cribriform plate and a submucosal nasoseptal collection of cerebrospinal fluid behind an intact septal nasal mucosa were detected in computerized tomography and magnetic resonance imaging studies. An endoscopic repair of the defect at the anterior cranial fossa was performed with a composite middle turbinate graft. Conclusion We suggest that even if anamnesis and radiological evaluation do not confirm rhinorrhea, dehiscence of bony roof and additional submucosal collection of fluids should be investigated in patients with recurrent meningitis.