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"Unexplained" delayed death from fungal meningitis after meningioma resection
R J Hurlbert1, J M Bilbao, W S Tucker
1Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.
Background:
Progressive deterioration and ensuing death following a neurosurgical procedure often represents a diagnostic challenge to the team responsible for patient care. Many, but not all, causes are treatable if a diagnosis is made early.
Methods:
A 69-year-old woman who died 6 weeks post-operatively following a meningioma resection is reported. An initial routine post-operative course became complicated by progressive neurological deterioration 3-4 weeks later. Despite extensive investigation she died 6 weeks post-operatively without a diagnosis.
Results:
Autopsy demonstrated extensive Candida meningitis. A review of the literature demonstrates this to be a reported complication in high risk patients, difficult to diagnose, but treatable when identified.
Conclusions:
Fungal meningitis should be high in the differential diagnosis in the post-operative patient with delayed, unexplained neurological deterioration, especially when associated with negative CSF cultures.
Insights
Delayed neurological deterioration after neurosurgery can be fatal. Autopsy revealed fungal meningitis, a treatable condition that should be considered in post-operative patients with unexplained decline, even with negative CSF cultures.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Neuropathology
Background:
- Post-neurosurgical neurological deterioration poses a diagnostic challenge.
- Early diagnosis of treatable causes is crucial for patient outcomes.
- Meningioma resection is a common neurosurgical procedure.
Observation:
- A 69-year-old woman experienced progressive neurological decline 3-4 weeks after meningioma resection.
- Despite extensive investigations, no diagnosis was made during her lifetime.
- The patient died 6 weeks post-operatively.
Findings:
- Autopsy revealed extensive Candida meningitis.
- Candida meningitis is a rare but serious complication in high-risk surgical patients.
- Diagnosis is challenging, often with negative cerebrospinal fluid (CSF) cultures.
Implications:
- Fungal meningitis should be considered in the differential diagnosis of delayed post-operative neurological deterioration.
- Early identification and treatment of fungal meningitis can improve patient prognosis.
- This case highlights the importance of considering uncommon infections in neurosurgical patients.