The incidental discovery of asymptomatic meningiomas and their conservative management are becoming more common with the growth in accessibility and use of neuroimaging. These asymptomatic meningiomas may predispose patients to certain risks, some of which can potentially be fatal.
This case describes a 75-year-old woman with known asymptomatic meningiomas and recent history of urosepsis who initially developed recurrent focal motor seizures before rapidly decompensating into super-refractory status epilepticus (SRSE) requiring general anaesthesia. MRI demonstrated the formation of abscess secondary to an infected meningioma (meningioma abscess). She underwent abscess resection and was managed with antibiotics and maintenance antiepileptic drugs post-operatively. The meningioma abscess culture grew the same organism as the urine culture from the preceding urosepsis, suggestive of haematological seeding. She was neurologically and clinically stable and remained seizure-free at three months follow up.
Only ten cases of meningioma abscesses have been reported to date. Risk factors or recent history for infection can be found in all cases. The three joint most common symptoms are fever, headache, and seizures. Our case illustrates the most potentially fatal sequela of meningioma abscess reported to date.
Meningioma abscess is an important differential/complication to recognise in patients with known meningioma in the context of systemic infection. This is becoming increasingly important as the incidental discovery of asymptomatic meningiomas and the proportion of elderly patients with comorbidities and immunosuppression continue to increase. Early suspicion and setting low thresholds for imaging can lead to timely management, improve prognosis, and avoid potentially fatal complications such as SRSE.
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