CASE HISTORY

Three weeks before admission patient had an attack of acute otitis media. This, however, settled down and was apparently clearing up when on the morning of admission at 5am he was taken acutely ill, he was sent to hospital but was comatose on admission. Left ear showed watery purulent discharge with perforation of the drum in the posterior quadrant. There was no redness of the drum and no mastoid swelling. Throat congested and dry, nose normal, right ear normal. Right eye deviated laterally, pupils normal size, equal, regular, did not react to light. Corneal reflexes absent. Limbs rigid with increased reflexes particularly on right side. Ankle clonus present both sides, plantar response not obtained. Kernig's sign faintly positive but no neck rigidity obtained. Cardio vascular system normal. Chest showed signs of bronchitis. Abdomen normal. Fundi normal. Lumbar puncture showed a purulent fluid under great pressure (over 300mms). CSF count:16,000 leucocytes per cm3, mostly polymorphs. Bacteriological examination showed pure culture of pneumococci. The patient died the same day.

PATHOLOGY

Brain 220mmx210mmx60mm. There is a generalised purulent meningitis. This is most severe at the base in the region of the interpeduncular area particularly on the left side of the specimen. It has however spread upwards towards the vertex as evidenced by the milky opacity of the meninges. There is no evidence of a cerebral abscess.