Bektas Devrim, Caylan Refik, Bahadir Osman, Caylan Rahmet
Department of Otolaryngology, Karadeniz Technical University, School of Medicine, 61040 Trabzon, Turkey.
Surg Neurol. 2007 Jul;68(1):50-2. doi: 10.1016/j.surneu.2006.11.039.
We present a case of recurrent meningitis in a patient with an occult skull base defect and without clinically or radiologically demonstrable rhinorrhea.
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.
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.
我们报告一例隐匿性颅底缺损且无临床或影像学可证实的鼻漏的复发性脑膜炎患者。
一名34岁女性患者出现头痛、发热和颈部疼痛，被诊断为急性化脓性脑膜炎。她的病史显示4年前上呼吸道感染后曾有过一次脑膜炎发作。她没有任何鼻漏主诉。鼻内镜检查及甲泛葡胺计算机断层扫描均未发现任何亚临床鼻漏。然而，计算机断层扫描和磁共振成像研究发现筛板有骨缺损，完整的鼻中隔鼻黏膜后方有脑脊液的黏膜下鼻中隔积聚。采用复合中鼻甲移植物对前颅窝缺损进行了内镜修复。
我们建议，即使既往史和影像学评估未证实鼻漏，对于复发性脑膜炎患者，也应检查骨顶裂开及额外的黏膜下积液情况。
