Neuroepithelial cyst presenting as recurrent aseptic meningitis

Area of Science:

• Neurology
• Neurosurgery
• Pathology

Background:

• Aseptic meningitis is an inflammation of the meninges not caused by bacterial infection.
• Recurrent meningitis necessitates a thorough etiological investigation to identify underlying causes.
• Choroid plexus cysts are intraventricular cysts that can sometimes cause neurological symptoms.

Observation:

• A 41-year-old male experienced three episodes of acute aseptic meningitis between ages 36 and 41.
• Each episode presented with severe occipital headache, mononuclear pleocytosis, and elevated cerebrospinal fluid (CSF) protein.
• A neuroepithelial cyst was identified originating from the choroid plexus in the right cerebellomedullary cistern.

Findings:

• The patient's recurrent aseptic meningitis was attributed to spontaneous ruptures of the neuroepithelial cyst.
• These ruptures likely led to a chemical meningitis due to the cyst's contents irritating the meninges.
• Cerebrospinal fluid analysis revealed mononuclear pleocytosis and increased protein, consistent with inflammatory meningitis.

Implications:

• Neuroepithelial cysts should be considered in the differential diagnosis of patients presenting with recurrent aseptic meningitis.
• This case underscores the importance of neuroimaging in identifying the source of unexplained meningitis.
• Understanding the pathophysiology of cyst rupture can guide management strategies for similar cases.