Mastoiditis With Pneumocephalus on CT: An Uncommon Clue to Underlying Bacterial Meningitis.

The combination of pneumocephalus and meningitis as a complication of mastoiditis is rare, with very few cases published in the literature. We report the case of a 33-year-old previously healthy male who presented with acute confusion, fever, agitation, and neck stiffness following a syncopal episode at work. CT imaging revealed opacification of the left mastoid air cells, suggestive of mastoiditis and pneumocephalus in the left frontoparietal region. Cerebrospinal fluid (CSF) analysis confirmed the diagnosis of pneumococcal meningitis. Empirical antibiotic treatment and steroids were initiated, and the patient survived without any neurological complications or deficits.