Journal of Diseases

Journal of Diseases

Current Issue Volume No: 1 Issue No: 1

Case-report Article Open Access
  • Available online freely Peer Reviewed

  • Late Onset Meningitis In Post Traumatic Temporal Meningoencephalocele

    1 Fellowship in pediatric infectious diseases, Iran University of Medical and Sciences, Tehran, Iran. 

    2 Professor of Pediatric Infectious Disease, pediatric infectious diseases Departement, Iran University of Medical Sciences. Tehran, Iran. 

    3 Pediatrician, Clinical Researcher, Iran University of Medical and Sciences, Tehran, Iran. 

    4 Pediatrician, Department of Neonatology, Iran University of Medical and Sciences, Tehran, Iran. 

    5 ENT and Head & Neck Research Center and department, Iran university of medical and sciences 

    Abstract

    Temporal lobe meningoencephalocele is an uncommon anomaly in the face. As brain tissue herniate through the dural imperfection, cerebrospinal fluid (CSF) or a mass will appear in the mastoid, middle ear or the both. Here we present a 10 years old boy with right lobe temporal meningoencephalocele which results in CSF leakage and manifested with bacterial meningitis. He had a history of head trauma and bone fracture 3 years ago. In surgery the defect repaired and the patient showed improvement.

    Author Contributions
    Received May 06, 2022     Accepted May 24, 2022     Published May 31, 2022

    Copyright© 2022 Sadr Zahra, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    Sadr Zahra, Noorbakhsh Samileh, Zafaranloo Nazanin, Moshfegh Fereshteh, Nasoori Yaser et al. (2022) Late Onset Meningitis In Post Traumatic Temporal Meningoencephalocele Journal of Diseases. - 1(1):2-9
    DOI 10.14302/issn.2997-1977.jd-22-4183

    Introduction

    Introduction

    Meningitis is an inflammation of the brain membranes and spinal cord. Bacterial meningitis etiology has been changed in recent decade due to H. Influenza (HIB), S. pneumonia and Meningococcal vaccination 12. It has different risk factors such as; head trauma, immune suppression, central nervous shunts, cerebrospinal fluid fistula/leak, neurological diseases , alcoholism, sinusitis, otitis media, pharyngitis, bacterial pneumonia, sickle cell disease, and congenital defects, age, social factors, exposures to pathogens, immunocompromising factors and drug usage 34567 cerebrospinal fluid analysis and culture is the best way for meningitis diagnosis. Some of the most complications that are associated with meningitis is; brain edema, hydrocephalus, infarcts, cerebral herniation and focal infection. They all need cranial CT scan for diagnosis 8.

    An encephalocele is a rare congenital neural tube defect. It happens when brain tissues protrude through a hole in the skull. Temporal bone encephaloceles manifest either as a mass or cerebrospinal fluid (CSF) in the middle ear or mastoid or both. Temporal lobe encephalocele is a rare disease. It is estimated about 1/3000 to 1/350009. There are two main etiologies for the temporal lobe encephalocele; acquired (traumatic fracture, radiation, erosions, tumors, etc.) and congenital skull base defects 10. Temporal lobe encephalocele does not have any specific signs and symptoms; so the diagnosis is with delay most of the time. The patient should expect a lot of complications such as seizures, abscess, meningitis and venous infarction, if remain untreated.

    Discussion

    Discussion

    An encephalocele usually happens when brain tissue herniates through a dural defect of the skull. Temporal bone encephaloceles show either as a mass or cerebrospinal fluid (CSF) in the middle ear or mastoid or both.

    Cerebrospinal fluid otorrhea and temporal lobe encephaloceles (TLEs) including the tegmen tympani also mastoide are infrequent. neurotologic conditions that have become more common in the past 10 years. 11

    Cerebrospinal fluid otorrhea and TLE come with serious aftermaths such as meningitis and brain abscesses, including conductive hearing loss and chronic middle ear effusion. 12

    All temporal bone CSF usually occur through the tegmen (tympani or mastoideum) and through the temporal lobe dura. Posterior fossa plate that leak over the cerebellum are not common. 13

    CSF leaks that are secondary to head trauma are well documented. It usually resolves spontaneously or with lumbar drainage within 1 to 2 weeks after the incident. 14

    Usually, Preparatory radiographic evaluation begins with a high-resolution computed tomography (CT) of the skull base. A magnetic resonance imaging (MRI) study is helpful to display for the presence of an encephalocele and may confirm that the effusion has a similar signal characteristic as CSF. If CT and MRI are non-diagnostic, other imaging formats such as a radionucleotide cisternogram study could be helpful. 15 The gold standard confirmatory test for a CSF fistula is the presence of beta-2 transferrin in the fluid that was used as a sample. 16

    A more frequent discovery is a soft compressible mass in the mastoid cavity comming off the tegment that may mimic a blue dome cyst or cholesterol granuloma. 17 Less frequent presentations include meningitis and seizures 1817.

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