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Mollaret's recurrent aseptic meningitis and cerebral epidermoid cyst
F J Aristegui1, R A Delgado, Z L Oleaga
1Department of Pediatrics, Basurto Hospital; University of the Basque Country; Bilbao, Spain.
Abstract:
A patient who initially presented with clinical and laboratory signs of bacterial meningitis developed four more similar episodes within a 6-month period. Immune system studies were unremarkable. A tentative diagnosis of Mollaret's meningitis was established after the third episode. Cranial computed tomography performed during the acute phase of the initial episode was normal, but, after the fourth scan, when the patient was asymptomatic, magnetic resonance imaging revealed a cyst in the anterior aspect of the medulla. Partial excision allowed for pathologic analysis, which established the diagnosis of epidermoid cyst. The differential diagnosis of recurrent aseptic meningitis should include Mollaret's meningitis and dermoid-epidermoid cysts. Neuroimaging studies, preferably magnetic resonance imaging, should be performed at a time when patients are asymptomatic.
Insights
Recurrent meningitis episodes in a patient were linked to an epidermoid cyst. Early neuroimaging, especially MRI during asymptomatic periods, is crucial for diagnosing rare causes of recurrent aseptic meningitis.
Area of Science:
- Neurology
- Pathology
Background:
- Recurrent meningitis presents a diagnostic challenge, often initially attributed to infectious causes.
- Mollaret's meningitis is a common consideration for recurrent aseptic meningitis.
Observation:
- A patient experienced multiple episodes of meningitis-like symptoms over six months.
- Standard immune studies were normal, and initial CT scans were unremarkable.
Findings:
- Magnetic resonance imaging (MRI) revealed a medullary epidermoid cyst in an asymptomatic patient.
- Pathologic analysis confirmed the cyst, establishing a rare cause for the recurrent meningitis.
Implications:
- Epidermoid cysts should be included in the differential diagnosis of recurrent aseptic meningitis.
- Asymptomatic neuroimaging, particularly MRI, is vital for identifying structural causes of recurrent meningitis.