Post-Craniotomy Titanium Plate with Chronic Symptoms

Case at a Glance

A 28-year-old male presents with chronic localized pain, sinus inflammation, and fatigue following titanium plate placement for cranial defect repair after bacterial meningitis treatment.

Patient's Story

The patient reports a history of bacterial meningitis in 2015 that required neurosurgical intervention. In 2018, he underwent cranioplasty with placement of a golf ball-sized titanium plate to repair a burr hole defect located superior to the left ear. Beginning in 2019, approximately one year post-cranioplasty, he developed persistent pain in the area surrounding the titanium implant. Concurrently, he began experiencing chronic sinus inflammation and reports significant ongoing fatigue that impacts his daily activities.

Initial Assessment

Patient presents with a triad of symptoms: localized cranial pain at the implant site, chronic sinusitis, and persistent fatigue. Physical examination reveals tenderness over the titanium plate area. The patient inquires about potential correlation between his metallic implant and systemic symptoms, specifically questioning whether the titanium plate could be causally related to his sinus inflammation and exhaustion.

The Diagnostic Journey

Initial clinical impression suggests the need to differentiate between implant-related complications and coincidental medical conditions. Diagnostic workup should include imaging studies to assess implant integrity and surrounding tissue response, inflammatory markers, and comprehensive metabolic panel to evaluate systemic causes of fatigue.

Final Diagnosis

Pending comprehensive evaluation to determine if symptoms represent implant-related complications, chronic sinusitis of alternative etiology, or concurrent medical conditions requiring separate management.

Treatment Plan

Systematic evaluation including CT imaging of the cranium and sinuses, laboratory assessment of inflammatory markers, and consideration of multidisciplinary consultation with neurosurgery and otolaryngology to address both cranial and sinus-related symptoms.

Outcome and Follow-up

Case requires ongoing evaluation to establish definitive diagnosis and appropriate treatment plan. Initial clinical opinion suggests implant-related causation of systemic symptoms is unlikely, necessitating investigation of alternative etiologies for the patient's chronic symptoms.