R. NICKBRYANMDS. JAMESZINREICHMD
A 66-YEAR-OLD WOMAN had a left acoustic neuroma removed more than 20 years earlier that resulted in a grade VI facial paralysis and anacusis of the left ear. Five years ago, she was diagnosed with a large recurrent tumor and underwent resection via a suboccipital approach. Her medical history was also significant for a Duke B carcinoma of the colon that had been resected several years earlier.
She was well until 4 months ago, when she became disorientated and was admitted to a local hospital with fever and neck stiffness. She did not complain of rhinorrhea or otorrhea. Before admission, she had been coughing because of an acute exacerbation of her bronchitis. On physical examination, there was evidence of a suboccipital craniectomy defect. The overlying skin was healthy and the incision had healed well. There were no cranial nerve abnormalities except for those of cranial nerves VII and VIII. A lumbar puncture revealed pneumococcal meningitis.
Chee NW, Niparko JK. Imaging Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2000;126(12):1499-1503. doi:10.1001/archotol.126.12.1499