[Aseptic meningitis caused by the rupture of an epidermoid cyst]. / Meningitis aséptica causada por la ruptura de quiste epidermoide.

INTRODUCTION: Epidermoid cysts are rare tumours. The aseptic meningitis that comes about as a result of their rupture is frequent after tumour resection, although they may occasionally occur spontaneously. CASE REPORT: A 36-year-old male who had been submitted to surgery twice because of an epidermoid cyst in the cerebellopontine angle presented a month old history of clinical features consisting in high temperature, headache, a stiff neck and ataxia. After computerized tomography (CT) scans and a spinal tap had been performed because of the suspicion of meningitis, empirical antibiotic therapy was administered but no improvement was observed. Thus, the usual studies employed to diagnose aseptic meningitis were carried out. Magnetic resonance imaging (MRI) was performed and showed lesions that suggested tumorous recurrence and perilesional meningeal hyperenhancement. Corticoid therapy quickly lessened the symptoms and the patient was asymptomatic when discharged. A week later he returned with headaches and disorders affecting behaviour and memory. A CT scan was performed and revealed the presence of tetraventricular hydrocephalus, which required the introduction of ventriculoperitoneal drainage. Spinal MRI carried out two weeks later revealed perimedullar foci of hyperenhancement. CONCLUSIONS: We describe the case of a patient with aseptic meningitis brought on by the rupture of an epidermoid cyst, which followed a subacute course and responded to corticoid therapy in a spectacular manner. Nevertheless, the patient still went on to develop tetraventricular hydrocephalus. Spontaneous aseptic meningitis is rare and corticoids lower its development time, but hydrocephalus may occur as a complication due to upsets in the reabsorption of cerebrospinal fluid.

Meningitis aséptica causada por la ruptura de un quiste epidermoide / Aseptic meningitis caused by the rupture of an epidermoid cyst

Introducción. Los quistes epidermoides son tumores raros. La meningitis aséptica ocasionada por su ruptura es frecuente después de la resección tumoral, aunque de forma inusual puede ocurrir espontáneamente. Caso clínico. Varón de 36 años intervenido en dos ocasiones de quiste epidermoide en el ángulo pontocerebeloso que presentaba una clínica de un mes de evolución consistente en fiebre, cefalea, rigidez de nuca y ataxia. Tras realizar una tomografía computarizada (TC) y una punción lumbar por la sospecha de meninigitis se administró tratamiento antibiótico empírico, pero no se observó mejoría, por lo que se realizaron los estudios habituales para el diagnóstico de meningitis aséptica. Se practicó una resonancia magnética (RM) que mostró lesiones sugestivas de recidiva tumoral e hipercaptación meníngea perilesional. El tratamiento con corticoides redujo rápidamente la sintomatología y el paciente fue dado de alta asintomático. Una semana después acudió por presentar cefalea y trastornos de la conducta y de memoria. Se realizó una TC que demostró la presencia de hidrocefalia tetracameral, la cual requirió la colocación de drenaje ventriculoperitoneal. En la RM espinal realizada dos semanas después se objetivaron focos perimedulares de hipercaptación. Conclusiones. Presentamos el caso de un paciente con meningitis aséptica originada por la ruptura de quiste epidermoide, que sigue un curso subagudo y responde espectacularmente al tratamiento corticoideo, a pesar de lo cual desarrolla hidrocefalia tetracameral con posterioridad. La meningitis aséptica espontánea es rara y los corticoides disminuyen su tiempo de evolución, pero puede complicarse con una hidrocefalia por alteración en la reabsorción del líquido cefalorraquídeo (AU)

Introduction. Epidermoid cysts are rare tumours. The aseptic meningitis that comes about as a result of their rupture is frequent after tumour resection, although they may occasionally occur spontaneously. Case report. A 36-year-old male who had been submitted to surgery twice because of an epidermoid cyst in the cerebellopontine angle presented a month old history of clinical features consisting in high temperature, headache, a stiff neck and ataxia. After computerized tomography (CT) scans and a spinal tap had been performed because of the suspicion of meningitis, empirical antibiotic therapy was administered but no improvement was observed. Thus, the usual studies employed to diagnose aseptic meningitis were carried out. Magnetic resonance imaging (MRI) was performed and showed lesions that suggested tumorous recurrence and perilesional meningeal hyperenhancement. Corticoid therapy quickly lessened the symptoms and the patient was asymptomatic when discharged. A week later he returned with headaches and disorders affecting behaviour and memory. A CT scan was performed and revealed the presence of tetraventricular hydrocephalus, which required the introduction of ventriculoperitoneal drainage. Spinal MRI carried out two weeks later revealed perimedullar foci of hyperenhancement. Conclusions. We describe the case of a patient with aseptic meningitis brought on by the rupture of an epidermoid cyst, which followed a subacute course and responded to corticoid therapy in a spectacular manner. Nevertheless, the patient still went on to develop tetraventricular hydrocephalus. Spontaneous aseptic meningitis is rare and corticoids lower its development time, but hydrocephalus may occur as a complication due to upsets in the reabsorption of cerebrospinal fluid (AU)