title: [A patient with confusion and pneumocephalus: what is your diagnosis?].
abstract: We report the case of a 58 year old male who presented with acute meningoencephalitis and pneumocephalus (intracranial air) visualized on head CT scan. Despite the lack of typical clinical signs such as retroauricular tenderness, red tympanic membrane or otorrhea, mastoiditis was suggested by head CT scan. The patient made a full recovery after mastoidectomy and six weeks of antibiotic therapy. Streptococcus pneumoniae grew from a surgical purulent mastoid tissue sample. Mastoiditis and its complications are rare in adults. A high level of clinical suspicion is needed when a patient presents with encephalitis of unclear origin.
authors.affiliation: Centre interdisciplinaire des urgences, Département de médecine interne, CHUV, Lausanne.
authors.forename: R
authors.initials: R
authors.lastname: Cavassini
authors.forename: E
authors.initials: E
authors.lastname: Guyot
authors.forename: N
authors.initials: N
authors.lastname: Theumann
authors.forename: M
authors.initials: M
authors.lastname: Cavassini
mesh_terms: D003221:Confusion / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008590:Meningoencephalitis / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D011007:Pneumocephalus / Q000209:etiology*; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed