MacKeith Samuel A, Soledad-Juarez Maria, Tiberti Liliana, Orfila Daniel
Department of Ear Nose and Throat Surgery, John Radcliffe Hospital, Oxford, UK.
BMJ Case Rep. 2014 Mar 10;2014:bcr2013010390. doi: 10.1136/bcr-2013-010390.
We describe the presentation, investigation and challenging management of a young adult with recurrent aseptic meningitis. The presence of cholesterol and triglycerides in the cerebrospinal fluid sample was recognised as a potential sign of an underlying dermoid or epidermoid cyst. We demonstrate how appropriate imaging of the skull base with diffusion-weighted imaging (DWI) MRI can help differentiate between lesions of the petrous apex, facilitating the diagnosis of a petrous apex congenital cholesteatoma/epidermoid cyst. Awareness of this unusual mode of presentation of a rare disease, as well as knowledge of key diagnostic investigations, may allow for earlier identification, treatment and reduced morbidity/mortality.
我们描述了一名患有复发性无菌性脑膜炎的年轻成年人的临床表现、检查及具有挑战性的治疗情况。脑脊液样本中胆固醇和甘油三酯的存在被认为是潜在的皮样或表皮样囊肿的迹象。我们展示了如何通过磁共振成像（MRI）的扩散加权成像（DWI）对颅底进行适当成像，有助于区分岩尖病变，从而促进岩尖先天性胆脂瘤/表皮样囊肿的诊断。认识到这种罕见疾病的不寻常表现方式以及关键诊断检查的知识，可能有助于早期识别、治疗并降低发病率/死亡率。
