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Posttraumatic Bacterial Meningitis

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Dr. Hand was supported in this study by special fellowship 5 FO3 AI40467, National Institute of Allergy and Infectious Diseases.

▸Requests for reprints should be addressed to W. Lee Hand, M.D., Department of Internal Medicine, University of Texas (Southwestern) Medical School at Dallas, 5323 Harry Hines Blvd., Dallas, Tex. 75235

Ann Intern Med. 1970;72(6):869-874. doi:10.7326/0003-4819-72-6-869-72-6-869
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A retrospective study on 16 adult patients was performed to characterize posttraumatic meningitis. Although eight patients developed meningitis within 2 weeks of injury, the delay was more than a year in four patients. All patients had either a demonstrable skull fracture or cerebrospinal fluid (CSF) rhinorrhea, or both. Six patients had recurrent meningitis. Diplococcus pneumoniae was the infecting agent in 83% of episodes. Only one patient died of meningitis. Surgical closure of the CSF fistula was accomplished in seven patients. Certain conclusions concerning management of posttraumatic meningitis appear reasonable. Penicillin in large doses should be administered unless organisms likely to be penicillin-resistant are seen on CSF smear. Meningitis patients with a history of head trauma should be evaluated for evidence of a CSF fistula. Surgical correction of the fistula seems to be indicated in patients with recurrent meningitis, late occurrence of meningitis, or persistent rhinorrhea.





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