Recurrent meningitis due to an intracranial epidermoid

Abstract

The association of intracranial dermoids and epidermoids and recurrent meningitis is usually related to the presence of dermal sinuses that allow bacterial entry. Epidermoid cysts rarely discharge their contents into subarachnoid space to cause meningitis, except after surgical removal. We describe a child who had 10 separate episodes of chemical meningitis between age 13 months and her death at age 2 years 9 months. Death was caused by an intra-axial epidermoid in the ventral pons which had ruptured into the subarachnoid space, as shown at autopsy. There was no evidence of sinus tracts, and radiographic studies revealed no mass.

Brainstem Epidermoid Cyst in a Child-Case Report-

“…EC located in the brainstem is extremely rare with only 19 reported cases. 2,4,7,8,[10][11][12][13]15,[17][18][19]22,23,27,29) Before computed tomography (CT) was introduced, only three cases were reported. 2,15,22) The prognosis has become favorable recently, but preoperative diagnosis is often difficult.…”

Two Autopsy Cases Assessing the Association of Rare Tumors Adjacent to the Sella turcica with Cause of Death and a Review of the Literature

“…Epidermoid cysts comprise about 1% of brain tumors and have only been reported in eight autopsies published in international journals [9][10][11][12][13][14][15][16]. The ages of the subjects in these reports range from 4-66 years (median: 36 years), which is relatively young, and there were six males and two females.…”

Pure Intrinsic brain stem epidermoid cyst: Case report, review of the literature and new classification

“…4,24,31,43,45 The proliferation of pluripotent embryonic remnants along the otic and optic cerebral vesicles can explain the occurrence of the majority of cranial epidermoids either in Cerebello pontine angle (CPA) or sellar areas. 4,14,24,43 Migration of embryonic ectodermal remnants along the Virchow-Robin spaces around the brain microvasculature.…”

“…During the surgery, one should be careful to avoid the spillage of the cyst contents into the subarachnoid space to avoid chemical meningitis and adhesions. 13,31,44 Conclusion: Brain stem epidermoids are rare tumors with uncertain pathogenesis. The age distribution of the reported cases ranged from one to 69 years with slight paediatric predominance.…”

“…Key words: Brainstem, Classifi cation, Epidermoid, Intrinsic cyst, telo-velo-tonsillar approach of pure intrinsic brain stem lesions, 12,13,27,29,33,35,44 and the juxta brain stem lesion either infi ltrated from surrounding cisternal spaces, 5,13,17,18,20,24,45 or extending into surrounding cisternal spaces8, [22][23][24][30][31][32]36. There is some amount of controversy prevailing in the pathogenesis morphological classifi cation13,24,43, author demarcated four different anatomical types of these tumors based on the epicentre of the tumor.…”