Recurrent meningitis due to an intracranial epidermoid

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.