A case of secondary bacterial meningitis against the background of transethmoidal meningoencephalocele

Abstract

The article represents a clinical case of secondary bacterial meningitis in a patient with meningoencephalocele, craniopathy rarely found in adults. The features of the course of the disease, diagnosis and treatment are discussed. Meningoencephalocele is a prolapse of the arachnoid membrane with brain substance due to craniopathy. Most cases of this disease are related to malformations detected in childhood. In adults, meningoencephalocele can be a consequence of injury, iatrogenesis, or some disease of unknown etiology. In this case, we can speak of spontaneous meningoencephalocele. The cause of this pathology is currently considered the effect of increased intracranial pressure on the "vulnerable" cranial areas: the Turkish saddle diaphragm, the walls of the sphenoid sinus, the ethmoid plate. Surgical treatment of intracranial hypertension is another factor likely to influence the occurrence of meningoencephalocele. Nasoliquorrhea is the most common symptom that causes patients with encephalocele health encounter. 33% of those are diagnosed with meningitis. Neuroimaging plays a key role in encephalocele diagnosis. Computed tomography of the brain can detect craniopathy. Leptomeningeal accumulation of contrast agent on T1-weighted images on magnetic resonance imaging indicates inflammation of the meninges in a patient with a clinical picture of meningitis. Encephalocele treatment is surgical. In the clinical case presented in this article, the patient with noncommunicating hydrocephalus and a history of surgical treatment of a colloid cyst was diagnosed with bacterial meningitis. Computed tomography of the head revealed a defect of the ethmoid bone and meningoencephalocele. The radiological signs of meningoencephalocele and meningitis are presented according to the data of magnetic resonance imaging in this patient. The patient underwent a two-stage surgical treatment with the use of endoscopic techniques and craniotomy. Four years after the operation, the radiological picture and the outcome of the disease were assessed.