DX: Chronic Sinusitis complicated to Meningitis

With those symptoms, the neurologist performed a spinal tap and revealed Meningitis.So, the main objective of this CT scan was to look for a hidden skull base fracture. As told, patient had history of recurrent sinus symptoms. His dad told us that he had had those problems since he was a kid and was treated as rinitis.  At examination patient had halitosis and a close examination revealed purulent discharge in nasal cavity. So, we searched in paranasal sinus for a fracture and signs of infection.

Here are the relevant images:

There was opacification of ethmoidal and frontal sinuses but a fair irregularity and asymmetry is seen in the right anterior skull base and roof of the orbit. We see a discontinuation in the outter table and a permeative desctrutive bone lesion in the inner table of the skull, almost a cavity. Borders of this cavity are sclerotic thus leading to a chronic inflammatory settting such as osteomyelitis. This is NOT a fracture, but in mild traumas can easlily lead to microleaks from frontal sinus that in fact, show also signs of infection. This confirms the origin of the Meninitis.

Volumetric 3D reconstruction algorithm gives us more spatial resolution and understanding of this problem:

This skull base cavity exposed meninges and eventualy provoked Meningitis. Patient was admited in the ICU but unfortunately died. CT scan control at 2 days (not shown) revealed severe Brain Edema and at 4 days revealed areas of Cerebritis.


Hope this case contributed to you as much as it did to me.

Thank you for your participation Dr. Chris Muñoz and Dr. Pedro Juarez.

CASE 39: 18y/o male patient with head trauma

Patient had head trauma 3 weeks ago but was reffered to us with acute altered mental status. He suffered a Grade I head trauma directly in the forehead with no loss of consciousness but with the course of days he proggresively developed neurological symptoms. At admision he had a GCS of 9. Previous CT scans (not shown) only reported mild brain edema due to effaced gyri. He didn't had history of drug abuse or any disease, only chronic sinusitis.

With a diagnosis in mind, we conduced a CT scan of the base of the skull. (Only relevant images are shown)

Findings?..later the conclusion.