Penetran meningoencephalitis and cerebro-spinal fluid fistula developing as a result of a house accident from a knitting needle

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Childhood head traumas are much more frequent in 1-3 year old period because of relatively lower levels of self-protection.Penetrating type head traumas constitute only a small part of these cases. Rhinorrhea develops in 2% of head traumas, and subsequent meningitis is seen in 7-30% of these cases. Treatment alternatives in cases with cerebrospinal fluid (CSF) leakage include CSF drainage, conservative and surgical treatment. A 13 months-old male infant, who had a knitting needle penetration history to his superior palate during in a home game was admittted to our hospital the day after the injury. He had vomiting, a decrease in sucking and fever complaints. He was letargic at admission, and he had anterior fontanel bulging in his physical examination. CSF analysis indicated meningitic findings, and cranial magnetic resonance imaging demonstrated meningoencephalitis. Vancomycin, cefotaxime and acyclovir were used as the treatment regimen. Rhinorrhea was determined on the next day of admission. However, fistula tractus could not be clearly demonstrated by computerized tomography. Consequenty, CSF drainage was applied every other day. Streptococcus pneumoniae was cultured in CSF specimens and herpes virus polymerase chain reaction was found to be negative. Therefore acyclovir treatment was terminated and the patient was discharged with complete recovery after a 10 day antibiotherapy.

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home accident , post , traumatic meningoencephalitis , cerebrospinal fluid fistula , rhinorrhea

Ege Journal Of Medicine

122

Ege Journal Of Medicine