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Table of Contents    
LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 3  |  Page : 314-315

Pneumocephalus as uncommon presentation of pneumococcal meningitis


1 Department of Neurology, Guglielmo Da Saliceto Hospital, Piacenza, Italy
2 Department of Infectious Diseases, Guglielmo Da Saliceto Hospital, Piacenza, Italy

Date of Submission26-Apr-2013
Date of Decision28-Apr-2013
Date of Acceptance30-May-2013
Date of Web Publication16-Jul-2013

Correspondence Address:
Eugenia Rota
Department of Neurology, Guglielmo Da Saliceto Hospital, Piacenza
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.115080

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How to cite this article:
Rota E, Sacchini D, Paolillo F, Morelli N, Immovilli P, Iafelice I, Guidetti D. Pneumocephalus as uncommon presentation of pneumococcal meningitis. Neurol India 2013;61:314-5

How to cite this URL:
Rota E, Sacchini D, Paolillo F, Morelli N, Immovilli P, Iafelice I, Guidetti D. Pneumocephalus as uncommon presentation of pneumococcal meningitis. Neurol India [serial online] 2013 [cited 2019 Sep 16];61:314-5. Available from: http://www.neurologyindia.com/text.asp?2013/61/3/314/115080


Sir,

Pneumocephalus is an uncommon, often forgotten complication of meningitis caused by gas-producing organisms. [1]

An 80-year-old woman, without any significant medical history, was admitted in a comatose state with fever. The brain and skull base computed tomography (CT) scan revealed multiple hypodense areas of air densities in the basilar cistern and along the cerebellar tentorium [Figure 1], without any bone defect. Magnetic Resonance Imaging (MRI) revealed right mastoiditis and left ethmoid sinusitis. Lumbar cerbrospinal fluid examination was positive for Streptococcus Pneumoniae (antigens and cultures). The patient was successfully treated with ceftriaxone/metronidazole and discharged a month later. The follow-up brain CT scan was unremarkable.
Figure 1: Computed tomography scan of the brain showing multiple multiple hypodense areas of air densities in the basilar cistern and along the cerebellar tentorium, (a) and (b) Axial scans (c) coronal scan (d) sagittal scan

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Pneumocephalus mostly arises as a complication of trauma, surgery and less frequently, of neoplasm, otitis media, post-radiation necrosis or sinusitis. Rarely have there been case reports of pneumocephalus associated with pneumococcal meningitis in immunocompetent patients with concomitant sinusitis or mastoiditis. [2],[3] The presence of bone dehiscence in the lateral sphenoid or temporal bones was detected in such cases and it was supposed to have been the cause of pneumocephalus. [4] In our patient, neuroimaging revealed mastoiditis and left ethmoid sinusitis, in the absence of any apparent osseous breach due to the inflammatory process. Spontaneous, non-traumatic pneumocephalus should raise the suspicion of meningitis and prompt adequate treatment, especially in the presence of suggestive clinical signs.

 
  References Top

1.Pantangi P, Cherian SV. Pneumocephalus: A rare presentation of Streptococcal meningitis. Intern Med 2011;50:2249-50.  Back to cited text no. 1
[PUBMED]    
2.Apostolakos D, Roistacher K. Pneumocephalus. Mayo Clin Proc 2007;82(11):1305.  Back to cited text no. 2
    
3.Damergis JA, Chee K, Amitai A. Otogenic pneumococcal meningitis with pneumocephalus. J Emerg Med 2010;39:E109-12.  Back to cited text no. 3
[PUBMED]    
4.Lefranc M, Peltier J, Demuynkc F, Bugnicourt JM, Desenclos C, Fichten A, et al. Tension pneumocephalus and rhinorrhea revealing spontaneous cerebrospinal fluid fistula of the anterior cranial base. Neurochirurgie 2009;55:340-4.  Back to cited text no. 4
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