Intratumoral abscess complicating a postradiation-induced World Health Organization grade II meningioma: illustrative
Katherine Callahan1, Isidora Beach1, Sadie Casale2
1Departments of1Neurosurgery and.
Background:
Cerebral meningiomas and brain abscesses are common independently, but intrameningioma abscesses rarely occur, with only 15 cases in the literature. These abscesses most frequently develop in patients with a known source of bacteremia; only one case of intrameningioma abscess without a known source of infection has been reported previously.
Observations:
This is the second reported case of an intrameningioma abscess without a clear source of infection, occurring in a 70-year-old female with a history of transsphenoidal craniopharyngioma resection and radiation many years prior. She presented with severe fatigue and altered mental status initially ascribed to adrenal insufficiency, and magnetic resonance imaging showed a new heterogeneously enhancing left temporal mass with surrounding edema. After urgent tumor resection, pathology demonstrated a World Health Organization grade II meningioma (radiation induced). After a course of steroids and intravenous nafcillin, the patient recovered without neurological deficits.
Lessons:
The natural history of intrameningioma abscesses is not fully understood. These uncommon lesions can form secondary to hematogenous spread facilitated by meningiomas' robust vascularization, typically in patients with bacteremia. Even when no significant source of infection is identified, the differential diagnosis of intrameningioma abscess should be considered because this pathology can be rapidly progressive, even fatal, but is treatable if recognized promptly.
Insights
Intrameningioma abscesses are rare, often linked to bacteremia. This case highlights a treatable instance without a clear infection source, emphasizing prompt diagnosis for this potentially fatal condition.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Intrameningioma abscesses are rare, with only 15 reported cases.
- Typically, these abscesses occur in patients with a known source of bacteremia.
- Previous literature reports only one case of intrameningioma abscess without a known infection source.
Purpose of the Study:
- To report a rare case of intrameningioma abscess.
- To discuss the diagnostic and management challenges of intrameningioma abscess without a clear source of infection.
Main Methods:
- A 70-year-old female with a history of craniopharyngioma resection and radiation presented with fatigue and altered mental status.
- Magnetic resonance imaging revealed a left temporal mass with surrounding edema.
- The patient underwent urgent tumor resection, followed by steroid and antibiotic treatment.
Main Results:
- Pathology confirmed a World Health Organization grade II meningioma (radiation-induced).
- The patient recovered without neurological deficits after treatment.
- This represents the second reported case of intrameningioma abscess without an identifiable source of infection.
Conclusions:
- The natural history of intrameningioma abscesses remains poorly understood.
- Meningiomas' vascularity can facilitate hematogenous spread, leading to abscess formation.
- Prompt recognition and treatment are crucial, as intrameningioma abscesses can be rapidly progressive and fatal, even without an identified infection source.
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