Delayed Diagnosis of Post-traumatic Temporal Lobe Meningo Encephalocele: A Rare Case Report of a Child

Bone fracture after head trauma is common in children. When a fracture happens in the temporal bone, Cerebrospinal fluid (CSF) might leak and/or the temporal lobe protrude (named encephalocele) as a mass inside the middle ear or mastoid or both.

Here, a 10 year old presents with an initial diagnosis of bacterial meningitis. Three years ago after head trauma he had a forgotten bone fracture. Incomplete improvement after primary treatment was achieved. Finally, after seeing a bone fracture on the right roof of the tympani and soft tissue mass in brain High-Resolution Compound Tomography (HRCT),surgical exploration determined the CSF leakage from a right lobe temporal meningo encephalocele. The bone defect was repaired and the patient had complete improvement.

In this case with forgotten post traumatic temporal bone fracture, temporal bone encephaloceles lead to CSF leakage inside the middle ear cavity and introduce bacterial meningitis. High-Resolution Compound Tomography (HRCT) of the cranial base defined the bone defect. In recent years, Magnetic Resonance Imaging(MRI) has been known as the best method for the diagnosis of brain tissue herniation in the middle ear cavity. Although to differentiate the encephalocele from other masses (e.g. granulation, cholesteatoma, cholesterol granuloma, etc.) inside the middle ear cavity in an MRI is not easy. Surgical multilayered closure of the dura and simultaneous repair of the bone defect is needed.