University of Toronto Neurosurgical Rounds no. 1. Massive osteolysis in association with multiple cerebrospinal fluid fistulae.

Reprint requests to: H.J. Hoffman, MD, Hospital for Sick Children, Division of Neurosurgery, Room 1504, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada CASE HISTORY A female child, TK, was born January 12, 1965, and was initially admitted to the Hospital for Sick Children, Toronto, on January 13, 1972, at age seven years with a sevenday history of runny nose, earache, headache, and fever. On the day before admission, she had a grand mal seizure and lumbar puncture revealed purulent cerebrospinal fluid (C.S.F.) which grew pneumococci. She was treated with antibiotics, her meningitis resolved, and she was discharged home nine days after admission. Over the next two years, she continued to drain fluid from her nose so that her mother would note a damp ring on her pillow. She was re-admitted on March 12, 1974 with a two-day history of headache, increasing drowsiness, and lethargy. She had a stiff neck and was febrile. Lumbar puncture showed a purulent pneumococcal meningitis. Blood culture grew pneumococci.