Open AccessRapidly fatal pneumococcal meningitis following non-penetrating traumatic brain injury
Author(s) -
Gustav Strandvik,
Ahmed Shaaban,
Abdelrahman Alsaleh,
Muhammad Ahsan Khan
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-232692
Subject(s) - medicine , pneumocephalus , traumatic brain injury , meningitis , head injury , intracranial pressure , streptococcus pneumoniae , head trauma , skull fracture , surgery , skull , antibiotics , pediatrics , computed tomography , psychiatry , microbiology and biotechnology , biology
A previously healthy young man presented to hospital with severe traumatic brain injury following a motor vehicle collision. Within 24 hours of admission, and despite antibiotic coverage, he developed a fever. On the second day, the source of infection was discovered to be purulent pneumococcal meningitis. At 48 hours post-accident, he developed brain-stem death without evidence of raised intracranial pressure or trans-tentorial herniation. Initial CT scans of the head were essentially normal, but early repeat scans revealed evidence of pneumocephalus and possible frontal bone fracture. Current recommendations do not make room for targeted antibiotic prophylaxis in traumatic brain injury patients with traumatic skull fracture. We argue that our case demonstrates the need for aggressive targeted antibiotic prophylaxis in the presence of certain features such as frontal or sphenoid bone fracture and pneumocephalus.