A case report on late presentation of occult dural lesions

Background: occult dural injuries are rare and can occur as a result of major or minor head injury. these injuries usually manifest with cerebrospinal fluid rhinorrhea alone,or with meningitis and cerebral abscess,sometimes many years after the original injury. case presentation: we present a case of occult dural injury with endocranial complications which occurred in a 34 year old man,with a history of head injury forty-three years ago. the patient presented with a triad of findings; meningitis,csf rhinorrhoea and pneumocephalus. he was managed conservatively with intravenous antibiotics and observation and made a full recovery. the presence of acute endocranial symptoms and particularly these three findings in a patient with a previous history of head injury,no matter how long it had been should raise suspicion of the presence of an occult dural injury. conclusion: it need to retain a high index of suspicion for occult dural injury in patients who present with endocranial symptoms of unknown origin,especially if there is a previous history of head injury.