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CPA-IAC Meningitis
Philip R. Chapman, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Leptomeningitis, infectious meningitis
            • Definitions

              • Acute or chronic infectious infiltrate of pia, arachnoid, dura and CSF in vicinity of temporal bone, internal auditory canal (IAC), and cerebellopontine angle (CPA)
              • Classified as acute pyogenic (bacterial), lymphocytic (viral) or chronic (tuberculous or granulomatous)

            IMAGING

            • General Features

              • Imaging Recommendations

                • CT Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    Selected References

                                    1. Marom T et al: Adult otogenic meningitis in the pneumococcal conjugated vaccines era. Int Arch Otorhinolaryngol. 24(2):e175-81, 2020
                                    2. Méchaï F et al: Tuberculous meningitis: Challenges in diagnosis and management. Rev Neurol (Paris). 175(7-8):451-7, 2019
                                    3. Wang B et al: Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. J Zhejiang Univ Sci B. 20(2):156-63, 2019
                                    4. Duarte MJ et al: Otogenic brain abscesses: a systematic review. Laryngoscope Investig Otolaryngol. 3(3):198-208, 2018
                                    5. Thakur KT et al: Chronic meningitis. Continuum (Minneap Minn). 24(5, Neuroinfectious Disease):1298-326, 2018
                                    6. Bruschini L et al: Otogenic meningitis: a comparison of diagnostic performance of surgery and radiology. Open Forum Infect Dis. 4(2):ofx069, 2017
                                    7. Leonard JM: Central nervous system tuberculosis. Microbiol Spectr. 5(2), 2017
                                    8. Mezochow A et al: Tuberculous meningitis in children and adults: New insights for an ancient foe. Curr Neurol Neurosci Rep. 17(11):85, 2017
                                    9. Taklalsingh N et al: Gradenigo's syndrome in a patient with chronic suppurative otitis media, petrous apicitis, and meningitis. Am J Case Rep. 18:1039-43, 2017
                                    10. Hildrew D et al: Management of complications of acute otomastoiditis in solid organ transplant patients. J La State Med Soc. 168(3):104-6, 2016
                                    11. Oliveira CR et al: Brain magnetic resonance imaging of infants with bacterial meningitis. J Pediatr. 165(1):134-9, 2014
                                    12. Mohan S et al: Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am. 22(4):557-83, 2012
                                    13. Lee MH et al: Prevalence and appearance of the posterior wall defects of the temporal bone caused by presumed arachnoid granulations and their clinical significance: CT findings. AJNR Am J Neuroradiol. 29(9):1704-7, 2008
                                    14. Tebruegge M et al: Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev. 21(3):519-37, 2008
                                    15. Smirniotopoulos JG et al: Patterns of contrast enhancement in the brain and meninges. Radiographics. 27(2):525-51, 2007
                                    16. Brown NE et al: Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope. 114(5):800-5, 2004
                                    17. Migirov L: Computed tomographic versus surgical findings in complicated acute otomastoiditis. Ann Otol Rhinol Laryngol. 112(8):675-7, 2003
                                    18. Stone JA et al: Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 20(4):706-12, 1999
                                    19. Quiney RE et al: Recurrent meningitis in children due to inner ear abnormalities. J Laryngol Otol. 103(5):473-80, 1989
                                    20. Vermeersch H et al: The temporal bone as route of infection in recurrent meningitis. J Otolaryngol. 9(3):199-201, 1980
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Leptomeningitis, infectious meningitis
                                              • Definitions

                                                • Acute or chronic infectious infiltrate of pia, arachnoid, dura and CSF in vicinity of temporal bone, internal auditory canal (IAC), and cerebellopontine angle (CPA)
                                                • Classified as acute pyogenic (bacterial), lymphocytic (viral) or chronic (tuberculous or granulomatous)

                                              IMAGING

                                              • General Features

                                                • Imaging Recommendations

                                                  • CT Findings

                                                    • MR Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      Selected References

                                                                      1. Marom T et al: Adult otogenic meningitis in the pneumococcal conjugated vaccines era. Int Arch Otorhinolaryngol. 24(2):e175-81, 2020
                                                                      2. Méchaï F et al: Tuberculous meningitis: Challenges in diagnosis and management. Rev Neurol (Paris). 175(7-8):451-7, 2019
                                                                      3. Wang B et al: Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases. J Zhejiang Univ Sci B. 20(2):156-63, 2019
                                                                      4. Duarte MJ et al: Otogenic brain abscesses: a systematic review. Laryngoscope Investig Otolaryngol. 3(3):198-208, 2018
                                                                      5. Thakur KT et al: Chronic meningitis. Continuum (Minneap Minn). 24(5, Neuroinfectious Disease):1298-326, 2018
                                                                      6. Bruschini L et al: Otogenic meningitis: a comparison of diagnostic performance of surgery and radiology. Open Forum Infect Dis. 4(2):ofx069, 2017
                                                                      7. Leonard JM: Central nervous system tuberculosis. Microbiol Spectr. 5(2), 2017
                                                                      8. Mezochow A et al: Tuberculous meningitis in children and adults: New insights for an ancient foe. Curr Neurol Neurosci Rep. 17(11):85, 2017
                                                                      9. Taklalsingh N et al: Gradenigo's syndrome in a patient with chronic suppurative otitis media, petrous apicitis, and meningitis. Am J Case Rep. 18:1039-43, 2017
                                                                      10. Hildrew D et al: Management of complications of acute otomastoiditis in solid organ transplant patients. J La State Med Soc. 168(3):104-6, 2016
                                                                      11. Oliveira CR et al: Brain magnetic resonance imaging of infants with bacterial meningitis. J Pediatr. 165(1):134-9, 2014
                                                                      12. Mohan S et al: Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am. 22(4):557-83, 2012
                                                                      13. Lee MH et al: Prevalence and appearance of the posterior wall defects of the temporal bone caused by presumed arachnoid granulations and their clinical significance: CT findings. AJNR Am J Neuroradiol. 29(9):1704-7, 2008
                                                                      14. Tebruegge M et al: Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev. 21(3):519-37, 2008
                                                                      15. Smirniotopoulos JG et al: Patterns of contrast enhancement in the brain and meninges. Radiographics. 27(2):525-51, 2007
                                                                      16. Brown NE et al: Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope. 114(5):800-5, 2004
                                                                      17. Migirov L: Computed tomographic versus surgical findings in complicated acute otomastoiditis. Ann Otol Rhinol Laryngol. 112(8):675-7, 2003
                                                                      18. Stone JA et al: Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 20(4):706-12, 1999
                                                                      19. Quiney RE et al: Recurrent meningitis in children due to inner ear abnormalities. J Laryngol Otol. 103(5):473-80, 1989
                                                                      20. Vermeersch H et al: The temporal bone as route of infection in recurrent meningitis. J Otolaryngol. 9(3):199-201, 1980