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KMID : 1130620080040010040
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Journal of Clinical Neurology
2008 Volume.4 No. 1 p.40 ~ p.44
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Recurrent Streptococcus Pneumoniae Meningoencephalitis in a Patient With a Transethmoidal Meningoencephalocele
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Yang Tae-Ho
Jeong Seul-Ki
Shin Byoung-Soo
Seo Man-Wook
Kim Young-Hyun
Jeong Seok-Young
Oh Sun-Young
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Abstract
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We report a case of recurrent Streptococcus pneumoniae meningoencephalitis with a transethmoidal meningoencephalocele (TEME) but without cerebrospinal fluid (CSF) leakage.
A 35-year-old man was admitted with S. pneumoniae meningitis. He had suffered from four episodes of recurrent
pneumococcal meningitis during the previous 4 years. A computed tomography scan of the paranasal sinus showed
the TEME protruding through a bony defect of the right frontal base. However, the patient did not have symptoms
that could be attributable to CSF leakage, and radioisotope cisternography did not identify a leak. Brain magnetic
resonance imaging revealed cortical lesions overlying the TEME, and electroencephalography revealed epileptiform
discharges in frontal regions. Appropriate antibiotics therapy without steroids was given to improve his condition.
The presented case suggests that even in the absence of clinically demonstrable CSF leakage, an occult skullbase
defect and its associated meningoencephalocele should be considered in patients with recurrent bacterial
meningitis.
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KEYWORD
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Recurrent meningitis, Streptococcus pneumoniae, Transethmoidal meningoencephalocele
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