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Washington University Experience | DEVELOPMENTAL MALFORMATIONS | Encephalocele - Nasal Glioma | 6A0 Case 6 History
Case 6 History ---- The patient is a 6 yo male with a history of a nasal mass who presented to an OSH on January 12th with fever and altered mental status. He reported headaches, vomiting and lethargy one day prior to admission. Upon arrival at the ED, he had neck stiffness and a positive Kernig's sign. He underwent a lumbar puncture revealing purulent CSF with 5585 WBCs, 176 RBC with 87% neutrophils and elevated protein at 207mg/dl. CSF PCR was positive for Strep pneumoniae confirming the diagnosis of pneumococcal meningitis. He started empiric Ceftriaxone and Vancomycin at meningitic dosing. On January 13th his mental status returned to baseline with resolution of fevers and CSF culture showed. MRI demonstrated a mass within the left nasal cavity extending from the left gyrus rectus consistent with a basal transethmoidal encephalocele extending into the left nasal cavity through an opening in the anterior left cribriform plate. Given the concerns for encephalocele with new diagnosis of meningitis he was referred to Pediatric Neurosurgery for surgical management.
