Pediatric acute bacterial meningitis is a life-threatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Given the potential trauma induced by the disease itself and the hospitalization, it is important to have an insight on how the parents cope with this aversive event, and especially how they give sense to this experience.

(1) To explore the lived experience of close family ascendants whose child or grandchild had survived acute bacterial meningitis (2) To investigate how they give meaning to this specific experience.

Participants were recruited through two association of persons affected by meningitis. Convenience sample of eleven family ascendants. Their family descendants were aged between 0.2 and 20 years old at the time of the meningitis diagnosis (M= 4.1, SD= 7.3). In average, 9.4 years had passed between the onset of illness and the relative’s interview (SD= 5.4).

6 superordinate themes and 2 meaning-making processes were identified: 1. Sick child becoming a “hero” (comparison with other children). 2. Engaged action/attitude: finding the “positive” of the traumatic experience and engaged action to improve the care system.

This is one of the first studies exploring the first-hand experience of family ascendants confronted to acute bacterial meningitis. Findings highlighted factors characterising the disease experience and the psychological adjustment of meningitis survivors’ families. They demonstred (1) the multidimensional impact of the disease on family ascendants and their need for professional psychological support, (2) the importance of direct involvement of parents in identifying key aspects of care.

Barotrauma to the middle-ear cavity and paranasal sinuses is a relatively common flight-related health problem. Occasionally, it may result in severe mechanical or infectious intracranial complications; these have been rarely reported to date.

Four cases of acute bacterial meningitis following air travel are presented, and its pathogenesis is briefly described.

Neurological symptoms occurring after air flight should prompt proper investigation. Otitis media and sinusitis are common primary focuses of bacterial meningitis. Severe complications of air flight barotrauma may be underreported.

Ecchordosis physaliphora is a congenital, benign lesion originating from notochordal remnants along the craniospinal axis, most frequently located at the level of the clivus and sacrum. Sometimes ecchordosis physaliphora is difficult to recognise and treat, with a total of twenty-six cases described in the literature.

This study reports on three cases of previously undiagnosed ecchordosis physaliphora presenting with cerebrospinal fluid rhinorrhoea and meningitis.

Endoscopic transclival or transsphenoid surgery including three-layer (fat, fascia and nasoseptal flap) reconstruction was used in all cases with complete resolution of the symptoms.

Central nervous system (CNS) may be infected by several agents, resulting in different presentations and outcomes. Analysis of cerebrospinal fluid (CSF) markers could be helpful to differentiate specific conditions and setting an appropriate therapy.

Patients presenting with signs and symptoms were enrolled if, before receiving a diagnostic lumbar puncture, signed a written informed consent. We analyzed CSF indexes of blood–brain barrier permeability (CSF to serum albumin ratio or CSAR), inflammation (CSF to serum IgG ratio, neopterin), amyloid deposition (1–42 β-amyloid), neuronal damage (Total tau (T-tau), Phosphorylated tau (P-tau), and 14.3.3 protein) and astrocyte damage (S-100β).

Two hundred and eighty-one patients were included: they were mainly affected by herpesvirus encephalitis, enterovirus meningoencephalitis, bacterial meningitis (Neisseria meningitidis and Streptococcus pneumoniae), and infection by other etiological agents or unknown pathogen. Their CSF features were compared with HIV-negative patients and native HIV-positive individuals without CNS involvement. 14.3.3 protein was found in bacterial and HSV infections while T-tau and neopterin were abnormally high in the herpesvirus group. P-tau, instead, was elevated in enterovirus meningitis. S-100β was found to be high in patients with HSV-1 and HSV-2 infections but not in those with Varicella Zoster Virus (VZV). Thirty-day mortality was unexpectedly low (2.7%): patients who died had higher levels of T-tau and, significantly, lower levels of Aβ1–42.

This work demonstrates that CSF biomarkers of neuronal damage or inflammation may vary during CNS infections according to different causative agents. The prognostic value of these biomarkers needs to be assessed in prospective studies.

To recount experience with cerebrospinal fluid otorrhoea and temporal bone meningoencephalocele repair in a tertiary care hospital.

A retrospective review was conducted of 16 cerebrospinal fluid otorrhoea and meningoencephalic herniation patients managed surgically from 1991 to 2016.

Aetiology was: congenital (n = 3), post-traumatic (n = 2), spontaneous (n = 1) or post-mastoidectomy (n = 10). Surgical repair was undertaken by combined middle cranial fossa and transmastoid approach in 3 patients, transmastoid approach in 2, oval window plugging in 1, and subtotal petrosectomy with middle-ear obliteration in 10. All patients had successful long-term outcomes, except one, who experienced recurrence after primary stage oval window plugging, but has been recurrence-free after second-stage subtotal petrosectomy with middle-ear obliteration.

Dural injury or exposure in mastoidectomy may lead to cerebrospinal fluid otorrhoea or meningoencephalic herniation years later. Congenital, spontaneous and traumatic temporal bone defects may present similarly. Middle cranial fossa dural repair, transmastoid multilayer closure and subtotal petrosectomy with middle-ear obliteration were successful procedures. Subtotal petrosectomy with middle-ear obliteration offers advantages over middle cranial fossa dural repair alone; soft tissue closure is more robust and is preferred in situations where hearing preservation is not a priority.