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• Vol.61 No.8
• CLINICA NEUROL, 61: 558−562, 2021
• Vol.61 No.8 contents

Case Report

A case of spontaneous middle cranial fossa cerebrospinal fluid leak presenting as recurrent bacterial meningitis

Takumi Tashiro, M.D.¹⁾, Atsushi Tsujimoto, M.D.¹⁾, Daisuke Abe, M.D.²⁾, Noritaka Komune, M.D., Ph.D.³⁾ and Norimichi Nakamura, M.D., Ph.D.¹⁾

¹⁾ Department of Neurology, Japan Community Healthcare Organization Kyushu Hospital
²⁾ Department of Otorhinolaryngology, Japan Community Healthcare Organization Kyushu Hospital
³⁾ Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University

A 19-year-old man with a history of Chiari type I malformation was admitted to our hospital two times within a 2-month period because of bacterial meningitis. Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis and hypoglycorrhachia. During the second admission, we became aware of hearing loss on the right since age 15 years. High-resolution temporal bone CT showed soft tissue opacification of the right epitympanum and external auditory canal. Tissue biopsy resulted in CSF otorrhea and pneumocephalus. CT cisternography revealed a temporal bone CSF leak. Brain MRI showed a dural defect localized to the anterior petrous apex. Using a combined middle cranial fossa-transmastoid approach, the dural defect and associated arachnoid granulations were located along the superior side of the greater petrosal nerve and repaired. A CSF leak without underlying pathology, such as trauma, surgery, or congenital abnormality, is defined as spontaneous. Spontaneous CSF leak should be considered as a cause of recurrent bacterial meningitis even when CSF otorrhea and fluid behind the tympanic membrane are clinically absent.
Full Text of this Article in Japanese PDF (1843K) 　　　　 Full Text of this Article in English HTML

(CLINICA NEUROL, 61: 558−562, 2021)
key words: recurrent bacterial meningitis, cerebrospinal fluid leaks, arachnoid granulations, Chiari malformation, high-resolution CT

(Received: 20-Feb-21)