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.