A Case with Surgical Repair for Delayed Occult Cerebrospinal Fluid Rhinorrhea Presented as Meningitis Fourteen Years After Blunt Head Trauma

摘要

We describe a case of a 34-year-old woman in whom delayed occult cerebrospinal fluid rhinorrhea presented as meningitis. Removal of an implanted shunt system and surgical repair of the fistula were required. The cerebrospinal fluid fistula was located in the left frontoethmoidal region. Fourteen years previously, the patient had been treated successfully for injury to the left internal carotid artery in a motor vehicle collision, by clipping and by implantation of ventriculoperitoneal and subduralperitoneal shunts to reverse the associated hydrocephalus. To prevent the spread of intracranial infection, we immediately removed the implanted shunt system and followed this by placement of lumbar drainage. After complete resolution of meningitis in response to antimicrobial agents, we performed surgical repair of the fistula. Shunt reconstruction was not required. The patient was discharged with good performance status. This case illustrates the point that effective treatment of meningitis is greatly facilitated by timely removal of associated foreign material.