Kodeeswaran M, Dhoka Gaurav R, Alagarsamy Jamila, Priyadharshan K P, Narinder Arun, Manivannan Panchabakesan, Chaurasia Bipin
Departments of Neurosurgery, Government Kilpauk Medical College and Hospital, Kilpauk, Chennai, Tamil Nadu, India.
Pathology, Government Kilpauk Medical College and Hospital, Kilpauk, Chennai, Tamil Nadu, India.
J Neurosurg Case Lessons. 2025 Jan 20;9(3). doi: 10.3171/CASE24358.
A 71-year-old male presented with weakness of the right upper limb and headache for the past 3 months. Brain magnetic resonance imaging (MRI) with contrast showed a left frontal space-occupying lesion, suggestive of a high-grade malignancy. Awake craniotomy with complete excision of the lesion was performed under immunofluorescence guidance. On postoperative day 2, the patient developed signs of meningoencephalitis and died. The histopathology report showed an abscess with parasitic infection, suggestive of primary amoebic meningoencephalitis (PAM), an infection caused by Naegleria fowleri.
The patient presented with the above symptoms. Intraoperatively, the lesion exhibited fluorescence uptake and had a firm consistency. The patient did not exhibit any new neurological deficits during surgery, but on postoperative day 2, signs of meningitis emerged, and his condition deteriorated, ultimately leading to his death.
PAM typically manifests with nonspecific symptoms of meningitis, progressing to a rapidly developing, severe form of meningitis that has a high mortality rate. The patient displayed obscure symptoms, and brain MRI revealed a space-occupying lesion with fluorescence uptake during surgery, suggestive of a high-grade malignancy. The diagnosis of PAM as a high-grade malignant space-occupying lesion was confirmed postmortem through histopathological analysis, a presentation considered exceedingly rare and unprecedented in the literature. https://thejns.org/doi/10.3171/CASE24358.
一名71岁男性在过去3个月出现右上肢无力和头痛症状。增强脑磁共振成像（MRI）显示左额叶占位性病变，提示为高级别恶性肿瘤。在免疫荧光引导下进行了清醒开颅手术并完整切除病变。术后第2天，患者出现脑膜脑炎症状并死亡。组织病理学报告显示为寄生虫感染性脓肿，提示原发性阿米巴脑膜脑炎（PAM），由福氏耐格里阿米巴引起的感染。
患者出现上述症状。术中，病变呈现荧光摄取且质地坚硬。手术过程中患者未出现任何新的神经功能缺损，但术后第2天出现脑膜炎症状，病情恶化，最终导致死亡。
PAM通常表现为非特异性脑膜炎症状，进而发展为快速进展、严重的脑膜炎形式，死亡率很高。该患者症状不明确，脑MRI显示手术中一个有荧光摄取的占位性病变，提示为高级别恶性肿瘤。通过组织病理学分析在尸检后确诊PAM为高级别恶性占位性病变，这种表现被认为在文献中极其罕见且前所未有的。https://thejns.org/doi/10.3171/CASE24358 。
