Chemical meningitis in ruptured intracranial dermoid. Case report and review of the literature

Intracranial dermoid cysts: variations of radiological and clinical features

“…Rightsided dilatation of the lateral ventricle was pre-existing, but intra-operative distribution of fatty particles probably caused full-blown occlusive hydrocephalus. The fatty intraventricular components may obstruct the Foraminae of Monro, the Foraminae of Luschka and Magendie or the aqueduct; furthermore, intra-operative retraction is a possible explanation for further displacement of fatty droplets and consecutive hydrocephalus [17,20,23]. If feasible, an en bloc resection of the dermoid is therefore desirable.…”

“…Various clinical aspects such as presentation with epileptic seizures, meningitis, focal neurological deficits, hydrocephalus, sudden death and incidental diagnosis have been reported. These acute symptoms associated with the presence of dermoids, their localisation and their rupture are well documented [1,2,5,14,15,17,18,20,23,26,33,[40][41][42]. Diagnostic findings were evaluated in the past but Gd Gadolineum, N/a not available, HCP hydrocephalus, n/v nausea/vomiting, DWI diffusion weighted imaging show strong individual variation [4,8,9,13,22,24,27,31,32,36,38,44,45].…”

Temporal Lobe Epilepsy Caused by Dermoid Cyst

“…1,6,[10][11][12][13] MR imaging can clearly reveal rupture of dermoid cyst. 5,6,11,13) Fat intensity within the ventricle and subarachnoid space, and sulcal widening by liquefied fat are pathognomonic signs of ruptured intracranial dermoid cyst. After rupture, the fat intensity in the cerebrospinal fluid space remains high for a long time.…”

“…Seizures are common secondary symptoms in patients with intracranial dermoid tumors, but generalized complex seizures are the most common type in reported cases. 1,2,5,10,11) Dermoid cysts in the temporal region rarely cause complex partial seizures. Intracranial dermoid cyst was associated with complex partial seizures in only one case.…”

Tetraventricular hydrocephalus due to ruptured intracranial dermoid cyst

“…Rupture of intracranial dermoids can occur in the subarachnoid spaces or in the ventricles. The spillage of the keratin and cholesterol breakdown products can generate variable clinical symptoms such as headache, dementia, seizures, loss of strength, or transient cerebral ischemia [1,2,3,4,5]. A chemically induced meningitis and chronic arachnoiditis frequently follow dermoid rupture with variable clinical sequela.…”