title: [A case with surgical repair for delayed occult cerebrospinal fluid rhinorrhea presented as meningitis fourteen years after blunt head trauma].
abstract: We describe a case of a 34-year-old woman in whom delayed occult cerebrospinal fluid rhinorrhea presented as meningitis. Removal of an implanted shunt system and surgical repair of the fistula were required. The cerebrospinal fluid fistula was located in the left frontoethmoidal region. Fourteen years previously, the patient had been treated successfully for injury to the left internal carotid artery in a motor vehicle collision, by clipping and by implantation of ventriculoperitoneal and subduralperitoneal shunts to reverse the associated hydrocephalus. To prevent the spread of intracranial infection, we immediately removed the implanted shunt system and followed this by placement of lumbar drainage. After complete resolution of meningitis in response to antimicrobial agents, we performed surgical repair of the fistula. Shunt reconstruction was not required. The patient was discharged with good performance status. This case illustrates the point that effective treatment of meningitis is greatly facilitated by timely removal of associated foreign material.
authors.affiliation: Department of Neurosurgery, Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi 738-8503, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Haruyoshi
authors.initials: H
authors.lastname: Taguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Yukawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kuroki
authors.forename: Junpei
authors.initials: J
authors.lastname: Ohshita
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ishihara
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D008581:Meningitis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt