WE BELIEVE that the classification of cases of otitic meningitis presented by Kerrison1 is the simplest, yet the most inclusive. He divided cases of otitic meningitis into those of circumscribed pachymeningitis and those of leptomeningitis.
Most aural surgeons have encountered circumscribed pachymeningitis accidentally during a mastoidectomy. The dura alone is inflamed and edematous, without the underlying structures being disturbed. The inflammation usually subsides promptly after removal of the surrounding necrotic bone. However, it undoubtedly is the precursor of more serious lesions.
The cases of leptomeningitis, which involves the pia and the arachnoid as well as the dura, were further subdivided by Kerrison into those of diffuse purulent, those of circumscribed purulent and those of serous leptomeningitis.
Diffuse purulent leptomeningitis is a suppurative inflammation of the meninges which has reached the subdural and subarachnoid spaces. The infection has spread widely, and there is no tendency on the part of the
FOERTSCH JH, FISCHER AJ. PNEUMOCOCCIC MENINGITIS: Presentation of a Case with Operation and Recovery. Arch Otolaryngol. 1949;49(6):637–642. doi:10.1001/archotol.1949.03760120064006
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