Recurrent pneumococcal meningitis. Search for occult skull fracture.

Skull fractures, particularly those affecting the base of the brain and extending to the sinuses and petrous pyramids, are the most common cause of recurrent bacterial meningitis. Detection of sinus fracture can be difficult in children. Thin-section computed tomographic scanning aids the diagnosis in patients with a remote history of head injury. Other causes of recurrent bacterial meningitis include congenital cranial and spinal cord defects, foci of infection, and immune system disorders. Streptococcus pneumoniae is often the infectious organism. Treatment includes surgical repair of any anatomic defects and use of appropriate antibiotic therapy.