Basilar Meningitis Associated With Ethmoid and Sphenoid Cephaloceles

Nontuberculous causes of basilar meningitis are rare. This study presents the case of a male who developed fever and meningitis caused by Streptococcus pneumoniae. He developed multiple cranial nerve palsies and imaging findings consistent with basilar meningitis and ventriculitis. Computed tomographic scans of the floor of the anterior fossa were performed after the detection of a cephalocele on magnetic resonance imaging. This imaging revealed a defect in the cribiform plate and fovea ethmoidalis with a large nasoethmoidal cephalocele. There was a second separate defect and cephalocele involving the middle cranial fossa. The association of basilar meningitis with an atypical organism should lead to a careful search for disruption in the floor of the anterior or middle cranial fossa.