Pneumocephalus in pneumococcal meningitis

Abstract

An 84-year-old woman with new onset mutistic behaviour and a fever of 40°C was found to have marked neck stiffness without any focal abnormalities. There was no immunosuppressive status. The cranial CT showed intracranial air in the posterior fossa (Figure 1A). Cerebrospinal fliud revealed a granulocytic pleocytosis (1,057/µl) with considerably elevated protein (7,080 mg/l) and lactate (14.4 mmol/l). The microbiological tests confirmed gram-positive diplococcae. Intensive care management and antibiotic therapy (ceftriaxone and ampicillin) was implemented. Examination of the ears showed moderate right-sided mastoiditis. Conservative treatment was advised and the patient recovered within 3 weeks.