Artikel
Chronic mastoiditis, acute bacterial meningitis and pontine infarction as late complications of a temporal bone fracture with cerebrospinal fluid fistula
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Autoren
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Dorothea Keymling
- HNO-Klinik/ AMEOS Klinikum St. Salvator Halberstadt, Halberstadt, Germany
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Wolfram Pethe
- HNO-Klinik/ AMEOS Klinikum St. Salvator Halberstadt, Halberstadt, Germany
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Klaus Begall
- HNO-Klinik/ AMEOS Klinikum St. Salvator Halberstadt, Halberstadt, Germany
| Veröffentlicht: | 8. Juli 2008 |
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Gliederung
Text
Persistent liquorrhoea is a rare complication of temporal bone fractures. These patients are at high risk of developing ascending intracranial infections.
We report the case of a 42 year old foreign man who developed oto- and rhinoliquorrhoea due to a temporal bone fracture from 1990 which had repeatedly been tried to stop by plastic surgery of the external auditory canal. 15 years later the patient was now admittet to our hospital, being unconcious after having felt increasing pain of the right ear for several days. CT scan showed an old fracture of the temporal bone with a cloudy right mastoid and inflammatory destruction of the temporal skull base.
Mastoidectomy was immediately performed and revealed an acutely exacerbated chronic inflammatory process through a defect of the temporal skull base. Antibiotics were given locally and systemically. By this, the inflammation improved rapidly. In the course of disease the patient developed pontine infarction on the left side. After spontaneous regression of the pathology the patient could be released into his home country for further treatment. Neurosurgical repair of the fistula after complete healing of meningitis was strongly recommended.
The risk of life threatening meningitis by chronic cerebrospinal leakage must not be underestimated and should receive sufficient surgical treatment, if necessary in collaboration with a neurosurgeon.
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