Post-Traumatic Meningitis: Case-Based Review of Literature from Internists’ Perspective

Abstract

Most cases of post-traumatic meningitis (PTM) occur following immediate head trauma or neurosurgical procedures. Hence, internists do not often come across these patients. However, closed-head trauma can be associated with community-acquired meningitis (CAM), and this history can often be missed especially if it is remote or trivial in nature. Therefore, meticulous clinical assessment is necessary to identify cases of community-acquired PTM. Knowledge about pathophysiological, anatomical, and microbiological context of community-acquired PTM is required in order to manage these patients. The role of internist is to provide holistic management in these patients which includes not only antimicrobial treatment but also timely referral to surgical specialties if required as well as vaccination to prevent further episodes. Here, we present a case of CAM with remote history of close head trauma and cerebrospinal fluid rhinorrhea for years who was found to have base of skull (BOS) defect on imaging of skull. He was treated with antibiotics and referred to surgical specialties for repair of BOS defect as well as given pneumococcal vaccine to prevent further episodes of meningitis.

Recurrent Meningitis in the Context of an Encephalocele

“…There is a case report about a 33-year-old, otherwise healthy male presenting with community-acquired meningitis who was later found to have a remote history of closed head trauma and CSF rhinorrhea for years. Imaging showed that he had a skull base defect [ 16 ]. Even though a traumatic fall injury could be a potential cause of closed head injury, she denied any injury to the head, thus ruling out closed head injury as a cause.…”

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: a retrospective Cross-Sectional Study

“…CSF should be acquired as soon as possible for analysis. (8)(9)(10)(11)(12)(13)(14)(15)(16) The most commonly found infectious pathogens are commensal organisms of the external auditory canal and nasopharynx in patients diagnosed with post-neurosurgical meningitis however the likelihood of nosocomial infection is recommended not to be overlooked. Aspiration of stomach contents is prevalent in individuals who have had a head injury, and it is typically worsened by bacterial super-infection.…”

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: A retrospective Cross-Sectional Study

“…CSF should be acquired as soon as possible for analysis. (8)(9)(10)(11)(12)(13)(14)(15)(16) The most commonly found infectious pathogens are commensal organisms of the external auditory canal and nasopharynx in patients diagnosed with post-neurosurgical meningitis however the likelihood of nosocomial infection is recommended not to be overlooked. Aspiration of stomach contents is prevalent in individuals who have had a head injury, and it is typically worsened by bacterial superinfection.…”