Meningitis due to mastoiditis extension
Findings:
Left sulcal effacement, tiny pneumocephalus, diffuse
meningeal enhancement, subdural effusions, severe left mastoid disease
Differential diagnosis:
meningitis, meningeal carcinomatosis/mets, intracranial
hypotension. The only reasonable diagnosis is meningitis given clinical
symptoms.
Discussion:
-bacterial meningitis- 80% H. influenzae, N. meningitidis,
S. pneumoniae
-organisms by age:
-neonates:
group B strep, E. Coli, listeria; young children: Hflu; children>7: NM;
adults: S. pneumo
-usually clinical dx (LP)
-CT usually normal +/- subarachnoid high attenuation/filling
simulating SAH +/- diffuse meningeal enhancement
-complications include hydrocephalus, abscess,
ventriculitis, infarction (venous or arterial)