Meningitis following fractures of the paranasal sinuses: accurate, non-invasive localization of the dural defect by direct coronal computed tomography.

A consecutive series of 30 patients admitted with non-meningococcal meningitis is presented. In all there was a history of preceding head injury. All 30 patients were investigated by direct coronal computed tomography (CT) scan to determine whether or not a site of fracture into a paranasal air sinus could be demonstrated. We postulated that such a fracture would correspond to the site of a dural tear. Direct coronal CT demonstrated a fracture in all patients, and this corresponded to the site of a dural tear at operation in every case in which an operation was carried out (28 out of the 30 patients). We propose that this method of investigation is superior to other techniques that have been, or are currently, employed in this clinical situation.