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A Journal on Neurosurgery

Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651

Frequency: Bi-Monthly

ISSN 0390-5616

Online ISSN 1827-1855


Journal of Neurosurgical Sciences 2000 March;44(1):46-52


Spinal seeding of anaplastic ependymoma mimicking fungal meningitis. A case report and review of the literature

Murakami M., Kuratsu J.-I-, Takeshima H., Soyama N., Shinojima N., Ushio Y.

Department of Neurosurgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860, Japan

Back­ground. ­The spi­nal seed­ing ­from ­brain ­tumors some­times mim­icks fun­gal men­in­gi­tis on exam­ina­tion of cere­bro­spi­nal ­fluid.
Meth­ods ­and ­results. A 19-­year-­old wom­an grad­u­al­ly devel­oped ­increased intra­cra­ni­al hyper­ten­sion. ­MRI iden­ti­fied a ­mass in ­the ­right parie­to-occip­i­tal ­area. It ­was total­ly ­removed ­and his­to­log­i­cal­ly diag­nosed as an ana­plas­tic epen­dy­mo­ma. Radi­a­tion- ­and chem­o­ther­a­py ­were admin­is­tered post­op­er­a­tive­ly. ­The ­patient report­ed ­low ­back ­pain 5 ­months ­after ­the sur­gi­cal treat­ment. ­MRI dis­closed nei­ther spi­nal dis­sem­i­na­tion ­nor ­tumor recur­rence at ­the pri­mary ­site. Lum­bar punc­ture ­was per­formed ­and ­the cere­bro­spi­nal ­fluid (­CSF) ­was ­found to ­have an extreme­ly ­low glu­cose lev­el (5 mg/dl); no ­tumor ­cells ­were iden­ti­fied. ­Blood sam­ples ­were ­obtained ­and a rel­a­tive ­increase of ­WBC ­and ­CRP ­was not­ed. A ­slight ­degree of inflam­ma­tion ­and ­low-­grade ­fever ­were record­ed. A ten­ta­tive diag­no­sis of fun­gal men­in­gi­tis ­was ­made ­and ­anti-fun­gal ther­a­py ­was admin­is­tered trans­ven­tric­u­lar­ly ­and trans­ve­nous­ly. How­ev­er, ­her neu­ro­log­i­cal con­di­tion con­tin­ued to dete­ri­orate grad­u­al­ly. Sequen­tial ­CSF stud­ies ­showed ­that ­the glu­cose lev­el ­remained extreme­ly ­low, it ­even ­decreased to 0 mg/dl. ­Eight ­months ­after ­the sur­gi­cal treat­ment, ­MRI ­with Gd-­DTPA ­revealed ­marked sub­arach­noid enhance­ment in ­both intra­cra­ni­al ­and spi­nal are­as. An ­open biop­sy ­was per­formed ­and a his­to­log­i­cal diag­no­sis of intra­cra­ni­al ­and spi­nal seed­ing of ­the ana­plas­tic epen­dy­mo­ma ­was ­returned.
Con­clu­sions. We ­report a ­patient ­with intra­cra­ni­al ­and spi­nal seed­ing of an ana­plas­tic epen­dy­mo­ma ­that mim­icked fun­gal men­in­gi­tis. We dis­cuss ­the dif­fi­cul­ty of obtain­ing a dif­fe­ren­tial diag­no­sis in ­this ­case ­and ­describe ­the mech­a­nism of ­the ­decreased ­CSF glu­cose lev­el.

language: English


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