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Extreme hypoglycorrhachia: not always bacterial meningitis
1Department of Medicine, Division of Infectious Diseases, Infection Control & Employee Health, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. gmviola@mdanderson.org
Nature Reviews. Neurology
|September 16, 2010
Summary
A rare case of chronic meningitis caused by cholesterol crystals in cerebrospinal fluid (CSF) was successfully treated with surgical cyst resection. This highlights a non-bacterial cause of extreme hypoglycorrhachia.
Area of Science:
- Neurology
- Neurosurgery
- Genetics
Background:
- A 55-year-old male presented with chronic meningitis, neutrophilic pleocytosis, and extreme hypoglycorrhachia (low CSF glucose).
- Initial work-up revealed no abnormalities, and symptoms relapsed after corticosteroid treatment.
- Imaging identified a sickle-shaped sacrum, rectal stenosis, and a presacral meningocele with an epidermoid-dermoid mass, suggestive of Currarino syndrome.
Observation:
- Lumbar puncture revealed cholesterol crystals in the cerebrospinal fluid (CSF).
- The patient exhibited symptoms consistent with Currarino syndrome.
Findings:
- Cholesterol crystals in CSF led to cholesterol-induced leptomeningitis.
- The patient was diagnosed with Currarino syndrome, characterized by sacral bone defects, hindgut anomaly, and a presacral tumor.
- Surgical resection of the communicating presacral cyst successfully managed the condition.
Implications:
- This case expands the differential diagnosis of extreme hypoglycorrhachia beyond bacterial infections.
- Highlights the importance of considering rare causes of meningitis and hypoglycorrhachia in neurological work-ups.
- Successful surgical management underscores the role of neurosurgical intervention in specific congenital anomalies presenting with neurological symptoms.
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