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Objectives: To highlight a case of unilateral Mondini's dysplasia and it's potential to manifest as paradoxical cerebrospinal fluid (CSF) rhinorrhoea and recurrent meningitis in an adult. Methods: A single case report with presentation and management of a patient with left sided Mondini's Dysplasia who presented with watery nasal discharge in the background of recurrent meningitis. We review the differential diagnoses and the importance of a multi-disciplinary approach to management. Results: Post-auricular approach was taken and the leak was identified at the footplate of Stapes and sealed with fascia lata. The middle ear was obliterated and blind sac closure was done. The patient made a good recovery. [ABSTRACT FROM AUTHOR]

Background: The clivus, a key skull base structure for neurosurgeons due to its proximity to brainstem areas, is formed by the fusion of two bones. A rare variation, the canalis basilaris medianus (CBM) or clival canal, can exist within the occipital bone. The clivus has a rich venous network, and the CBM's presence might be linked to veins or embryonic structures. Understanding the CBM is valuable for interpreting clival fractures and during neurosurgery. This study aimed to determine the frequency and morphometric parameters of the CBM. Material and methods: Fifty-nine dry adult skulls were selected for the investigation. Morphometric measures included establishing the diameters of the internal and external foramina of the CBM, the length of the canal, and its distance from the foramen magnum (FM), jugular tubercles, and lateral margins of the basilar part of the occipital bone. Results: Out of the 59 skulls investigated, only a single specimen contained the CBM. Thus, the frequency of canal presence in our sample was 0.59 %. The internal foramen of the CBM was located on the internal surface of the clivus, 4.03 mm anteriorly to the FM with a diameter of 2.84 mm. Further, the canal passed through the clivus and had its external foramen on the external surface of the clivus at 0.11 mm above the pharyngeal tubercle and its distance from the FM was 9.19 mm. The length of the CBM was established at 8.16 mm. Conclusion: The CBM is a rare variation of the basilar part of the occipital bone. Therefore, the possibility of the existence of this variation should be considered when analyzing CT and MRI images to avoid misinterpretation of their results and during surgical interventions in this area.

Spontaneous cerebrospinal fluid (CSF) oto-rhinorrhoea is rare and may develop secondary to inner ear malformation. Any child discharging watery fluid through nose or ear spontaneously in a head dependent position should be a high index of suspicion of CSF leak. If watery rhinorrhoea is present then apart from biochemical analysis of fluid discharge to confirm it to be CSF, computed tomography of paranasal sinuses and temporal bone should be carried out to differentiate between CSF oto-rhinorrhoea and CSF rhinorrhoea. Congenital deformities of the inner ear can be associated with meningitis and varying degrees of hearing loss. Here we describe two cases, one of CSF oto-rhinorrhea in a 1 year old child who presented with spontaneous watery rhinorrhoea following violent projectile vomiting of 1 month duration. On evaluation, child was found to have CSF oto-rhinorrhoea with right Mondini deformity and profound hearing loss on right side. 2nd case was of 12 years old male with profound hearing loss right ear and recurrent episodes of meningitis diagnosed as common cavity malformation of inner ear. Both children underwent closure of CSF leak from oval window successfully. There was no recurrence after more than 1 year of follow up. Congenital inner ear malformations are an important cause of recurrent meningitis in children and require a high index of suspicion for diagnosis. Thorough clinical evaluation and radiological study is suggested in all cases of CSF oto-rhinorrhoea for the identification inner ear malformation and management of CSF oto-rhinorrhoea. Patients who receive an accurate and early diagnosis can avoid severe complications and have a good prognosis. [ABSTRACT FROM AUTHOR]

Recurrent benign lymphocytic meningitis (RBLM) is an uncommon form of aseptic meningitis characterized by the recurrence of meningeal symptoms followed by spontaneous recovery. Historically, RBLM has been attributed to herpes simplex virus (HSV) type 2 infection. Diagnosis is traditionally confirmed by PCR of viral DNA isolated from the CSF. Although the disease course is usually benign, antiviral therapy may benefit some patients. Here, we report the case of a young woman diagnosed with four episodes of aseptic meningitis within 10 years. The presence of HSV type 2 in the CSF was confirmed using PCR in three of the episodes. After the resolution of acute attacks, the patient was symptom-free with no neurological sequelae. [ABSTRACT FROM AUTHOR]

Objectives: Congenital cerebrospinal fluid (CSF) leaks of the ear can be a potential cause of recurrent meningitis. Diagnosing the otogenic cause can be a challenge due to the spectrum of presentations. We aim at studying the various modes of presentation, radiology, and intraoperative findings of such CSF leaks. Methodology: This was a retrospective study of six patients of recurrent meningitis. Detailed history and clinical signs were noted. Audiometry was done. Computed tomography (CT) scan of the paranasal sinus and high-resolution CT of the temporal bone were done. CT cisternography was done for confirmation. Magnetic resonance brain was done in the immediate postmeningitic phase when CT cisternography is contraindicated. All the cases were explored surgically to identify and repair the site of the leak. Results: One had unilateral deafness and five had bilateral deafness. Two had incomplete partition (IP)-I deformity and four had IP-II. Surgical exploration revealed the leak site as only oval window in three patients and both round and oval windows in two. Conclusion: Otorhinology consultation is a must for all cases of recurrent meningitis. It is important to pick up subtle clinical signs for diagnosis. Multiple leak sites should be anticipated in such cases intra-operatively. [ABSTRACT FROM AUTHOR]

Introduction. Herpes simplex virus type 2 (HSV-2) is recognized as one of the most common causes of aseptic meningitis, that is also а well-known complication of genital herpes. We report a case of recurrent HSV-2 meningitis without genital lesions, but with simultaneous skin lesions that were a clue for diagnosis. Case presentation. A 21-year-old man had two episodes of aseptic meningitis in 2019 and 2021, respectively. During both episodes, the neurological manifestations were preceded by recurrent herpetic skin lesions on the right arm. HSV-2 deoxyribonucleic acid (DNA) was detected in the spinal fluid only in the first episode. However, due to the possibility that the lesions and simultaneous episodes of meningitis were caused by HSV-2, systemic acyclovir was initiated. Each time, the treatment was followed by rapid symptoms’ resolution. After the second episode, the patient was put on indefinite suppressive therapy with valacyclovir. Conclusions. Recurrent skin lesions can suggest the probability of HSV-2 etiology of concomitant meningitis and justify the initiation of acyclovir. In all confirmed meningitis cases with HSV-2, counseling on this genital infection and the possibility of sexual spread should be considered.

Ventriculoperitoneal shunts are the current treatment of choice for congenital hydrocephalus. It is rare for physicians to see patients with alternative types of shunting devices. Lumboureteral shunts, once popular from the 1940s to 1960s, decompress via the genitourinary system. Immediate complications were dehydration, electrolyte imbalances, infection, and the sacrifice of a functional kidney. Long-term complications include retrograde meningitis due to urinary tract infections. Three shunt types have been documented: polyethylene, silicone rubber, and ureterodural anastomosis. Routine imaging cannot detect a ureterodural anastomosis, and if suspected, computed tomography myelogram is needed for confirmation. This article presents the case of a man with long-standing ureterodural anastomosis that required ligation after recurrent episodes of acute meningitis secondary to urinary retention.

We present the case of a 5-year-old girl who had six episodes of meningitis. She also had panhypopituitarism and was found to have a persistent craniopharyngeal canal (CPC) as the cause of her recurrent meningitis. Role of neuroradiology and a high index of suspicion by the clinical team are highlighted here. Persistent CPC is a rare cause of recurrent meningitis. We discuss the approach to the child with recurrent meningitis.

Background Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases. Methods We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis. Results Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43–66), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1–15). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2–5 previous episodes (25%), 2 had 6–10 episodes (2%), and 2 had >10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, <5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P <.001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P <.001). Conclusions Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients. [ABSTRACT FROM AUTHOR]

Abstract Background Meningitis is a life-threatening infection often associated with high morbidity. Recurrent bacterial meningitis poses a clinical challenge, both clinically and diagnostically. To prevent further recurrences, the underlying causes of recurrent bacterial meningitis should be investigated intensively. Case presentation Here, we aim to present a patient referred to our clinic with rhinorrhea and found to the Staphylococcus aureus meningitis related to a clival defect. The patient reported no history of trauma, surgery, or brain neoplasm, and the cerebrospinal fluid leakage was classified as spontaneous. The patient had two episodes of meningitis in the last 4 years, but etiologic data of the previous episodes were absent. A pneumococcal vaccine was administered following her second attack, suggesting a possible Staphylococcus aureus infection due to altered colonization in the sinuses. She was successfully treated with linezolid but refused surgery to correct the defect and was discharged without neurologic sequelae. Conclusion Spontaneous cerebrospinal fluid leakage from the clivus which could provoke recurrent meningitis is a rare situation. In conjunction with appropriate rapid antibiotherapy for the prevention of recurrent meningitis, the removal of anatomical risk factors should be a principal aim. Effective surgical procedures prevent recurrences.

Le syndrome de Bing-Neel est une atteinte neurologique rare, rencontrée au cours de la macroglobulinémie de Waldenström, et définie par la présence de lymphoplasmocytes monoclonaux dans le liquide cérébro-spinal ou la biopsie de tissu cérébral. Nous rapportons l'observation d'un homme de 47 ans, sans antécédents, qui présentait une méningite lymphocytaire aseptique récidivante associée à des signes neurologiques centraux. La présence de lymphoplasmocytes monoclonaux et de la mutation MYD88 dans le liquide cérébrospinal, le sang, associée aux résultats de la biopsie ostéomédullaire permettait de conclure au diagnostic de syndrome de Bing-Neel. Malgré une abstention thérapeutique, l'évaluation à 4 mois ne retrouvait pas de récidive de la symptomatologie ni de progressions des lésions à l'IRM. Nous rapportons une observation de syndrome de Bing-Neel révélé par une méningite récidivante, dont l'évolution à 4 mois était stable en l'absence de traitement. Bing-Neel syndrome is a rare complication of Waldenström macroglobulinemia, defined by monoclonal lymphoplasmocytic cells in the cerebrospinal fluid or in central nervous system biopsy. We report a 47-year-old man, with no prior history, who presented a recurrent aseptic lymphocytic meningitis with central nervous manifestations. The presence of a monoclonal lymphoplasmacytic proliferation in cerebrospinal fluid, blood and bone marrow biopsy results was compatible with a diagnosis of Bing-Neel syndrome. Despite the absence of any specific treatment, there was no recurrence of symptoms at 4-month follow-up, and the MRI lesions remained stable. We report a case of Bing-Neel syndrome revealed by a recurrent meningitis. Outcome without treatment was favorable at 4-month follow-up. [ABSTRACT FROM AUTHOR]

The article reports a clinical case of a patient with four recurring episodes of headache, nausea and focal neurological symptoms (hemiparesis, sensorimotor aphasia, adversive epileptic seizures) with a rapid onset of remission. The clinical picture of the disease was supplemented with lymphocytic pleocytosis and cell-protein dissociation in the cerebrospinal fluid, which allowed to diagnose benign recurrent lymphocytic meningitis (Mollaret meningitis) and to conduct pathogenetic therapy. The aim of this work is to improve the diagnosis of rare Mollaret meningitis.

We present the case of a 5-year-old girl who had six episodes of meningitis. She also had panhypopituitarism and was found to have a persistent craniopharyngeal canal (CPC) as the cause of her recurrent meningitis. Role of neuroradiology and a high index of suspicion by the clinical team are highlighted here. Persistent CPC is a rare cause of recurrent meningitis. We discuss the approach to the child with recurrent meningitis. [ABSTRACT FROM AUTHOR]

Most posttraumatic cerebrospinal fluid fistulas are accompanied by rhinorrhea and the physician can easily diagnose a fistula (leakage) in case of a traumatic event. Nevertheless, cases of fistulas occurring many years after the head injury have been reported in literature. We report the rare case of a 19-year-old female patient with a penetrating head injury and 3 years long-term posttraumatic cerebrospinal fluid fistula complicated with recurrent meningitis.

Introduction: Meningitis is a potentially life threatening illness. It requires prompt diagnosis and treatment. Recurrent meningitis needs detailed investigations to identify the underlying cause., Observation: We report a case of recurrent pneumococcal meningitis in a 9-year-old boy with an underlying congenital skull base abnormality. Brain computed tomography (CT) scan showed no obvious skull base defects. A magnetic resonance imaging (MRI) of the brain revealed a dehiscence of the cribriform plate with encephalomeningocele. The patient underwent an endoscopic repair of the bony defect and had not developed any new infections ever since., Conclusion: This case highlights the need to investigate recurrent bacterial meningitis with CT scan and MRI of the brain and skull base. Repair of these congenital skull base defects are mandatory to prevent the recurrence of meningitis.

Introduction: Congenital anomalies of the cochlea and labyrinth can be associated with meningitis and varying degrees of hearing loss or deafness. Despite antibiotics, meningitis remains a life threatening complication. Case Report: We report a case of recurrent meningitis following episodes of otitis media in a cochlear implantee child with bilateral vestibulocochlear malformation, due to fistula in the stapes footplate. Intrathecal fluorescin was used to identify the leak site. Conclusion: Recurrent meningitis can indicate for possible immunological or anatomical abnormalities as well for chronic parameningeal infections. Intraoperative use of intrathecal fluorescin is an ideal investigative tool to demonstrate cerebrospinal fluid (CSF) leak site in patients in whom other investigations fail to do so.

Purpose: Post-traumatic CSF leaks are a complication in 2% of all head injuries. Majority of these patients will recover spontaneously. Whilst recent literature has predominantly centred on CSF leaks and their general investigations and management thereof, there is a paucity of information when it comes to those patients who have persistent post-traumatic CSF leaks, as well as the complication of recurrent meningitis. We present a patient with a persistent post-traumatic CSF leak who presented with recurrent bacterial meningitis thirteen times- the highest documented amount in an adult. We reviewed the literature with regards to the above as well. Material and Methods: We reviewed a vast array of journal articles on the topic of CSF leaks from the PubMed resource, and focused this review specifically on those that documented patients who had uncorrected CSF leaks and their outcomes. Results: Complications include meningitis and rhinorrhoea with brain abscesses and pneumocephalus occurring less frequently. Mortality has been documented to be 9% after 1 year. The rates of persistent CSF leaks were within the same range with an average calculated rate of 21%. Whilst meningitis was recorded and is common, it was not stipulated whether the incidences were recurrent. Conclusion: Post-traumatic persistent CSF leaks remain a therapeutic challenge and continued follow-up with early surgical intervention is highly recommended to prevent complications. One of the more serious complications of a persistent leak is meningitis. The long-term outcomes of recurrent meningitis could include cumulative focal neurological deficitis and cognitive impairment. [ABSTRACT FROM AUTHOR]

Purpose: Recurrent meningitis in children is a rare condition. However, its early recognition is important in order to prevent serious complications. This study aims to review cases of recurrent meningitis in children.Methods: This is a retrospective study that included children diagnosed with recurrent meningitis and who were followed at child neurology clinic at the Jordan University Hospital from January 2001 to June 2017.Results: Thirteen patients were included (nine males and four females). Age of first episode of meningitis ranged from 2 months to 9.5 years. The delay in diagnosis of the underlying cause after the first episode ranged from 6 months to 2.5 years. Underlying causes included inner ear malformation in one patient, skull fractures in two, and dermal sinuses (thoracic spinal and occipital dermal sinus) in two patients. No identifiable cause was found in eight patients. Streptococcus pneumoniae was identified in four (31%) patients, Staphylococcus aureus in two (15%), and no organism was isolated in seven (54%). Three patients (23.1%) developed neurological sequel including developmental delay, limb spasticity, and epilepsy. Two patients had sensorineural hearing loss related to meningitis, and two patients had sensorineural hearing loss mostly related to their original disease.Conclusion: A detailed history, examination, and thorough investigations are necessary to determine the underlying cause of recurrent meningitis. In addition, in patients with positive CSF bacterial culture, finding the underlying etiology is very likely. [ABSTRACT FROM AUTHOR]

Background: The intrathecal contrast-enhanced magnetic resonance cisternography (MRC) is a diagnostic method that has been proven effective in selected patients with various disorders of the cerebrospinal system, including the detection of cerebrospinal fluid (CSF) leaks. The Mondini dysplasia is a malformation of the inner ear characterized by an incomplete cochlear development. The cerebrospinal fistula associated with Mondini dysplasia usually occurs in the first 5-10 years. Case Description: The case of a 34-year-old woman with CSF rhinorrhea and recurrent meningitis associated with CSF fistula into the right inner ear, which was detected by MRC with intrathecal gadolinium, is presented. The computed tomography (CT) cisternography failed to detect the exact location of the leak. The right Mondini dysplasia was identified on CT of the temporal bone. A subtotal right-sided petrosectomy and fistula closure into the bony labyrinth were performed. After the procedure the patient no longer presented meningitis or CSF leak. Conclusions: The radiological identification of the site of CSF leak through sensitive imaging studies such as MRC with intrathecal gadolinium is crucial for surgical approach. [ABSTRACT FROM AUTHOR]

We present a rare case of Mollaret's meningitis in a young patient with seven prior episodes of recurrent meningitis. The patient presented with headache, fever, neck stiffness, nausea, and vomiting. Brain imaging revealed no acute abnormalities. Lumbar puncture revealed elevated nucleated cells with lymphocytic predominance. The patient was started on antimicrobials including acyclovir. Cerebrospinal fluid polymerase chain reaction was positive for herpes simplex virus type 2. Her 2-day hospital course was uncomplicated, and she was discharged in good condition. Mollaret's meningitis, also known as recurrent benign lymphocytic meningitis, is a rare clinical disorder characterized by at least three recurrent episodes of meningitis associated with spontaneous recovery with or without antiviral therapy. Herpes simplex virus type 2 has frequently been implicated in the setting of this illness. [ABSTRACT FROM AUTHOR]

Recurrent bacterial meningitis is very rare phenomenon in paediatric age group. Finding the aetiology of recurrent meningitis often poses diagnostic challenge to clinicians. Among the several aetiologies, structural deficiencies at the base of skull, congenital or acquired, are readily correctable ones and hence it’s imperative to find out the location of the gap in order to surgically repair it. We report the diagnostic dilemma faced while managing a 15-year-old boy with recurrent pneumococcal meningitis. Aetiology could only be found after exclusion of immunodeficiency and performing a series of imaging studies. CT cisternogram clinched the diagnosis and patient was cured successfully. A single imaging modality, be it CT/MRI scan, although proven to be better than others according to literature, might not be sufficient while finding the cause of recurrent bacterial meningitis in an immunocompetent host.

Introduction: Leakage of cerebrospinal fluid in the skull base may be accompanied with recurrent meningitis. The site of leakage may either be anterior (in the nose and paranasal sinuses) or posterior (in the temporal bone). Various imaging techniques can be used to precisely locate the point of leakage but despite all the advances in imaging techniques there are still some rare cases in which the surgeon can’t be sure on the management approach before the beginning of surgery. Case Report: In this article we present one of these cases; we used intrathecal fluorescein to locate the source of the leak and made the final decision on the operating table. Conclusion: Intrathecal fluorescein is helpful in locating the leakage in the ear or the nose in ambiguous cases.

Subdural empyema (SDE) is an uncommon entity, mostly associated with meningitis and can be life threatening in infants. Rarely, a subdural empyema can lead to nasal encephalocele which can be challenging situation to manage especially in infant. We present a case of 7 month old infant who presented with subdural empyema that led to formation of nasal encaphalocele after 4 months which was managed endoscopic route. [ABSTRACT FROM AUTHOR]

We present a case of a 23-month old female with congenital malformation of her inner ear and perilymphatic fistula due to stapes footplate defect leading to recurrent episodes of bacterial meningitis and resulting bilateral profound hearing loss. Multiple-layer closure with obliteration of the malformation, middle ear and mastoid along with closure of the external auditory canal was performed to achieve definitive repair. Cochlear implantation in the contralateral ear resulted in age-appropriate language proficiency with excellent CI speech perception over a 12-year follow up. The importance of multiple-layer closure for adequate repair and early consideration of cochlear implantation are highlighted. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes, risk factors, treatment, and prognosis for recurrent meningitis. As a general overview of a broad topic, the aim of this review is to provide clinicians with a comprehensive differential diagnosis to aide in the evaluation and management of a patient with recurrent meningitis.Recent Findings: New developments related to understanding the pathophysiology of recurrent meningitis are as scarce as studies evaluating the treatment and prevention of this rare disorder. A trial evaluating oral valacyclovir suppression after HSV-2 meningitis did not demonstrate a benefit in preventing recurrences. The data on prophylactic antibiotics after basilar skull fractures do not support their use. Intrathecal trastuzumab has shown promise in treating leptomeningeal carcinomatosis from HER-2 positive breast cancer. Monoclonal antibodies used to treat cancer and autoimmune diseases are new potential causes of drug-induced aseptic meningitis. Despite their potential for causing recurrent meningitis, the clinical entities reviewed herein are not frequently discussed together given that they are a heterogeneous collection of unrelated, rare diseases. Epidemiologic data on recurrent meningitis are lacking. The syndrome of recurrent benign lymphocytic meningitis described by Mollaret in 1944 was later found to be closely related to HSV-2 reactivation, but HSV-2 is by no means the only etiology of recurrent aseptic meningitis. While the mainstay of treatment for recurrent meningitis is supportive care, it is paramount to ensure that reversible and treatable causes have been addressed for further prevention. [ABSTRACT FROM AUTHOR]

Introduction Skull base meningoencephaloceles are rare congenital malformations. The two cases of transalar transsphenoidal malformation reported here differ from the classical transsphenoidal meningoencephalocele. Case reports Case 1 was a three-and-a-half-year-old boy and case 2 was a 36-year-old man. Both cases presented with clinical features of recurrent meningitis. Surgical management of case 1 was performed via an intradural infratemporal fossa craniotomy with reoperation 2 years later. In the second case, surgery was initially performed via an endonasal approach and then via pterional craniotomy. Reoperation via Sekhar's transpetrosal approach was also a failure. Only closure of the trigeminal-pontine angle via a suboccipital retrosigmoid approach allowed repair of the defect. Discussion Surgical access to the pterygopalatine fossa is complex due to its anatomical position and its anatomical relations with nerves and vessels. An endoscopic approach appears to be a valuable alternative to classical craniotomy. Conclusion In the two cases reported here, neurosurgery allowed lasting closure of the defect. [ABSTRACT FROM AUTHOR]

To report a case of pediatric recurrent meningitis that is associated with an underlying petrous apex encephalocele in a patient with bilateral cochlear implants and reviews the literature of similar petrous apex lesions. A 5-year-old girl presented during her third episode of meningitis. Her first episode of meningitis left her with profound bilateral sensorineural hearing loss for which she received cochlear implants. During her assessment, she was found to have a petrous apex encephalocele, which was successfully repaired via a middle cranial fossa approach. Literature review demonstrates that petrous apex cephaloceles (PAC) are associated with meningitis, particularly in children. No previous reports exist of PAC in patients with cochlear implants. This case illustrates the importance of identifying an underlying anatomic abnormality in recurrent meningitis. PAC are rare abnormalities that can cause cerebrospinal fluid leaks leading to intracranial hypotension, cranial neuropathies, and infectious complications. [ABSTRACT FROM AUTHOR]

Abstract Mondini dysplasia is a developmental disorder of the inner ear structures and it is a rare cause of recurrent bacterial meningitis in children. A 10-year-old boy presented with acute febrile encephalopathy and right ear pain. In the past, he had suffered from two distinct episodes of pyogenic meningitis. On examination, he had signs of meningeal irritation and right ear sensorineural deafness. Magnetic resonance imaging of the brain and computerized tomography of the temporal bone was suggestive of Mondini dysplasia in the right ear. Our case highlights the need for (a) screening of hearing loss at the bedside by Rinne and Weber test in case of recurrent bacterial meningitis (b) searching for an underlying inner ear malformation if there is a hearing loss. [ABSTRACT FROM AUTHOR]

Introduction: Congenital anomalies of the cochlea and labyrinth can be associated with meningitis and varying degrees of hearing loss or deafness. Despite antibiotics, meningitis remains a life threatening complication. Case Report: We report a case of recurrent meningitis following episodes of otitis media in a cochlear implantee child with bilateral vestibulocochlear malformation, due to fistula in the stapes footplate. Intrathecal fluorescin was used to identify the leak site. Conclusion: Recurrent meningitis can indicate for possible immunological or anatomical abnormalities as well for chronic parameningeal infections. Intraoperative use of intrathecal fluorescin is an ideal investigative tool to demonstrate cerebrospinal fluid (CSF) leak site in patients in whom other investigations fail to do so. [ABSTRACT FROM AUTHOR]

Nasofrontal dermoid with sinus tract extending to the nasal tip is rare in adults. It is unique in its embryological origin, presentation, and management. Pathogenesis involves the incomplete obliteration of the developing neuroectoderm. A sinus opening with intermittent oily discharge is characteristic. Associated intracranial extension may lead to meningitis and brain abscess. We present a case of a 21-year-old adult having a nasofrontal sinus tract with intracranial extension who presented with recurrent episodes of meningitis and discuss the physical findings with relevance to embryology, elaborating on the importance and means of addressing the intracranial as well as extracranial components for complete treatment. [ABSTRACT FROM AUTHOR]