Recurrent bacterial meningitis caused by an occult basilar skull fracture

Abstract

We present a rare case of recurrent bacterial meningitis caused by an occult basilar skull fracture. A 9-year-old boy presented with acute headache, fever and vomiting. He had recurrent meningitis episode one month earlier and a head trauma 6 months ago. Laboratory findings and lumbar puncture suggested an intracranial bacterial infection. Computerized tomography, magnetic resonance imaging and nasal endoscopy failed to find the presence of rhinorrhea. Spiral computed tomography was performed and a three-dimensional reconstruction of the bony cranium was done. A diagnosis of bone defect in the ethomoid was made. An endoscopic operation was performed to repair the defect successfully and the child was completely normal during a 4-month follow-up. The skull base should be evaluated radiologically to find one or multiple bony defects in case of recurrent meningitis in absence of cerebrospinal fluid rhinorrhea. Compared to other neuroradiological technologies, three-dimensional computed tomography provides a better three-dimensional definition of the basilar skull fracture for both diagnosis and surgical planning. When the fracture is located in the anterior skull base, an endoscopic transnasal approach is considered the best option.