Abstract
Bacterial meningitis is one of the most life-threatening neurological
emergencies. Delayed diagnosis and management results in high morbidity
and mortality. Although most cases of bacterial meningitis do not have a
precise mechanism, local spread from adjacent structures, such as the
ear, nose, and throat is not uncommon. Many bacterial species cause
bacterial meningitis; however, Streptococcus pneumoniae is the
most frequent lethal pathogen. The cerebrospinal fluid (CSF) is often
turbid with an elevated white blood count and proteins. We present a
case of a middle-aged man who had chronic otitis media that caused acute
fulminant bacterial meningitis due to Streptococcus pneumoniae.The CSF consisted of frank pus and neuroimaging indicated extensive
parenchymal damage with thick exudates in the CSF spaces. There was also
radiological evidence of cerebral venous thrombosis. Our case is a rare
case of the CSF changing to a frank pus-like appearance. The CSF white
blood cell count was highly elevated, not reported in prior literature.
The radiological findings reported in this case are unique and highly
educational.