Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of nasal discharge resulting in recurrent bacterial meningitis

Naoki Takao, M.D.1), Kenzo Sakurai, M.D., Ph.D.1), Sakae Hino, M.D.1) and Yoshihisa Yamano, M.D., Ph.D.1)

1) Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine

A 47-year-old man who was previously hospitalized three times due to bacterial meningitis experienced a headache and posterior neck pain in May. He was admitted to our hospital because of a fever 3 h later. He was fully conscious and febrile, with a headache and signs of meningeal irritation. A cerebrospinal fluid examination showed an increased number of cells with polynuclear cell predominance and decreased glucose levels, leading to the diagnosis of bacterial meningitis. Steroid and antibiotic treatment was initiated, at which time, large amounts of nasal discharge were observed. Cisternal scintigraphy was performed, and cerebrospinal fluid was detected in the nasal discharge. The cause was idiopathic, and endoscopic repair was performed. The nasal fluid leakage was suggested to be the cause of the recurrent bacterial meningitis in this case.
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(CLINICA NEUROL, 61: 177|181, 2021)
key words: meningeal irritation, bacterial meningitis, cerebrospinal rhinorrhea, cisternal scintigraphy

(Received: 29-Jun-20)