Penetran meningoencephalitis and cerebro-spinal fluid fistula developing as a result of a house accident from a knitting needle
Abstract
Childhood head traumas are much more frequent in 1-3 year old period because of relatively lower levels of selfprotection. 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.
Abstract
Çocukluk çağı kafa travmalarına, kendisini korumada yetersiz kalan bir-üç yaş grubunda daha sıklıkla rastlanmaktadır. Kafa travmaları olguların küçük bir kısmında penetran özellik göstermektedir. Kafa travmalarının %2'sinde rinore görülmekte olup bu olguların %7-30'unda menenjit gelişmektedir. BOS sızıntısı gösteren olguların tedavi seçenekleri arasında konservatif tedavi ile BOS drenajı ve cerrahi girişim bulunur. Evde oynarken üst damağına örgü şişi batan, izlemde kusma, ateş ve emmede azalma gelişen 13 aylık erkek bebek, travmadan bir gün sonra hastanemize getirildi. Gelişinde letarjik olan hastanın fizik muayenesinde ön fontanelde bombelik, BOS analizi ile MR görüntülerinin incelemelerinde ise kraniyal meningoensefalit tanısı konan hastaya vankomisin, sefotaksim, ve asiklovir başlandı. Başvurusundan bir gün sonra rinoresi olduğu öğrenilen, ancak BT'de fistül yeri saptanamayan hastaya gün aşırı BOS drenajı uygulandı. BOS'ta streptococcus pneumoniae üremesi ve herpes virüs PCR'ın negatif saptanması üzerine asiklovir tedavisi kesilen hasta, 10 günlük antibiyototik tedavisinden sonra şifa ile taburcu edildi.
Details
| Other ID | JA44JR34YZ |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | June 1, 2010 |
| Submission Date | June 1, 2010 |
| Published in Issue | Year 2010Volume: 49 Issue: 2 |