An Adult Case of Pneumocephalus and Pneumococcal Meningitis Associated with the Sphenoid Sinusitis

Abstract

A 60-year-old man was admitted to our hospital after being found at his home in a comatose state. Cerebrospinal fluid and blood cultures were positive for Streptococcus pneumoniae. Brain magnetic resonance imaging (MRI) revealed sinusitis in the sphenoid sinus. Computed tomography demonstrated the presence of multiple air pockets in the basilar cistern, and we diagnosed pneumococcal meningitis complicated with pneumocephalus. Multiple cerebral infarctions were found on brain MRI after admission. In this case, pneumocephalus was secondary to pneumococcal meningitis due to sinusitis on admission, and multiple cerebral infarctions after admission. We demonstrated that early diagnosis is required for the successful treatment of pneumococcal meningitis.

Case of pneumococcal meningitis associated with pneumocephalus

“…Although pneumocephalus results from various etiologies, bacterial meningitis associated with pneumocephalus is rare . As pneumococcus is not capable of gas production, the intracranial air in the present case might have resulted from the CSF leakage through the minute cranial defects caused by the sinusitis.…”

Pneumocephalus due to meningitis extending from sphenoid sinusitis: Case report and review of literatures

“…Until today, a total of seven cases of sphenoid sinusitis with pneumocephalus have been reported. [2][3][4][5][6][7][8] These previously reported cases and our case are summarized in Table 1. Patients' age was relatively young.…”

“…[4][5][6] These bony erosion or defect might contribute to invasion of pathogens into intracranial space. As for pathogens, in two cases, 5,8 bacteria were detected from the CSF. In two cases, pathogens were detected by culture of pus in the sphenoid sinus, an anaerobic bacteria 2 and fungus.…”

“…We treated a young adult patient presenting with pneumocephalus secondary to meningitis in association with isolated sphenoid sinusitis. To our knowledge, five cases of pneumocephalus accompanied by isolated sphenoid sinusitis have been reported in the English literature, [2][3][4][5][6] and two in the Japanese literature. 7,8 In this report, we present our experience of treatment, review of the previous cases, and discuss clinical and radiological characteristics of a case of pneumocephalus induced by meningitis extending from sphenoid sinusitis.…”

Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

“…However, most reported cases of meningitis complicating pneumocephalus are accompanied by otogenic infection with communication between the middle ear and either middle or posterior cranial fossa through bony defects [1], or pneumocephalus complicating meningitis with sinusitis [2]. Rarely, gas-forming bacterial infection could cause pneumocephalus via hematogenous spread [3].…”