# Mastoiditis With Pneumocephalus on CT: An Uncommon Clue to Underlying Bacterial Meningitis

## TL;DR

A rare case of mastoiditis with pneumocephalus leading to bacterial meningitis is reported, highlighting an unusual clinical presentation and successful treatment.

## Contribution

This case adds to the limited literature on pneumocephalus as a clue to bacterial meningitis complicating mastoiditis.

## Key findings

- Pneumocephalus on CT imaging was associated with bacterial meningitis in a patient with mastoiditis.
- The patient was successfully treated with empirical antibiotics and steroids without neurological deficits.
- The case underscores the importance of considering meningitis in patients with mastoiditis and pneumocephalus.

## Abstract

The combination of pneumocephalus and meningitis as a complication of mastoiditis is rare, with very few cases published in the literature. We report the case of a 33-year-old previously healthy male who presented with acute confusion, fever, agitation, and neck stiffness following a syncopal episode at work. CT imaging revealed opacification of the left mastoid air cells, suggestive of mastoiditis and pneumocephalus in the left frontoparietal region. Cerebrospinal fluid (CSF) analysis confirmed the diagnosis of pneumococcal meningitis. Empirical antibiotic treatment and steroids were initiated, and the patient survived without any neurological complications or deficits.