title: Occult anterior skull base defect without rhinorrhea as a cause of recurrent meningitis.
abstract: BACKGROUND
  We present a case of recurrent meningitis in a patient with an occult skull base defect and without clinically or radiologically demonstrable rhinorrhea.
  
  
  METHODS
  A 34-year-old female patient presented with headache, fever, and cervical pain and was diagnosed with acute purulent meningitis. Her medical history revealed another meningitis episode following an upper respiratory tract infection 4 years before. She did not have any rhinorrhea complaint. Nasal endoscopy and computerized tomography with metrizamide failed to demonstrate any subclinical rhinorrhea. However, a bony defect in the cribriform plate and a submucosal nasoseptal collection of cerebrospinal fluid behind an intact septal nasal mucosa were detected in computerized tomography and magnetic resonance imaging studies. An endoscopic repair of the defect at the anterior cranial fossa was performed with a composite middle turbinate graft.
  
  
  CONCLUSIONS
  We suggest that even if anamnesis and radiological evaluation do not confirm rhinorrhea, dehiscence of bony roof and additional submucosal collection of fluids should be investigated in patients with recurrent meningitis.
authors.affiliation: Department of Otolaryngology, Karadeniz Technical University, School of Medicine, 61040 Trabzon, Turkey. devrimbektas@yahoo.com
authors.forename: Devrim
authors.initials: D
authors.lastname: Bektas
authors.forename: Refik
authors.initials: R
authors.lastname: Caylan
authors.forename: Osman
authors.initials: O
authors.lastname: Bahadir
authors.forename: Rahmet
authors.initials: R
authors.lastname: Caylan
mesh_terms: D000328:Adult; D001847:Bone Diseases / Q000150:complications* / Q000601:surgery; D035262:Cranial Fossa, Anterior / Q000601:surgery; D003560:Cysts / Q000473:pathology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000209:etiology*; D009296:Nasal Cavity / Q000000981:diagnostic imaging; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000473:pathology; D012008:Recurrence; D020545:Respiratory Mucosa / Q000473:pathology / Q000601:surgery; D019291:Skull Base / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014420:Turbinates / Q000637:transplantation