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Clinical Challenge Bacterial meningitis CASE Ms. M, aged 73 years, was brought to the neuroscience clinic by her daughters. She was alert, pleasantly complicated by confused, and using a wheelchair for mobility because of concurrent right knee antalgia and seizures and confusion edema. The initial physical exam was unremark- able. Ms. M’s daughters provided details about CASE AND ANALYSIS BY STEPHANIE her medical history, which was signiﬁcant for an CHRISTIAN-LOBLEY, FNP-BC, APNP, CCRN, CNRN idiopathic transnasal cerebrospinal ﬂuid (CSF) leak that was repaired via bifrontal craniotomy The seizures began following surgery to 20 years ago. Since that time, she has experienced recurrent episodes of bacterial meningitis. The repair a cerebrospinal ﬂuid leak. last episode occurred approximately two weeks earlier, and she was admitted to the hospital for treatment. After discharge, she and her daughters reported colorless transnasal drainage consistent with CSF. At the neuroscience clinic, MRI revealed a 3.4-cm peripherally enhancing extra-axial ﬂuid collection within the anterior aspect of the left middle cranial fossa (likely representing abscess or infected arachnoid cyst) and areas of leptomeningeal enhancement within the skull. MRI indicated possible incomplete treatment of Ms. M’s recent bacterial meningitis. Additionally, a right sphenoid sinus surgical defect at the base of the skull was identiﬁed as a potential source of the current CSF leak. Ms. M was admitted to the neurosurgical nursing ward in anticipation of repair of the
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