Ruptured Spinal Ependymoma Simulating Bacterial Meningitis

Abstract

An intraspinal tumor can rupture, causing subarachnoid hemorrhage or pleocytosis, and produce signs of severe meningeal irritation and fever. When pleocytosis is prominent, serious confusion with bacterial meningitis may result. In the case reported here, a cauda equina ependymoma presented severe meningeal signs with fever and pleocytosis following its rupture into the subarachnoid space. Initially, bacterial meningitis was suspected and intensive antimicrobial therapy was given, without improvement. Subsequently myelography, performed to rule out a spinal abscess, showed a cauda equina tumor. Following its surgical removal, the meningeal signs and fever subsided quickly and the patient recovered completely. REPORT OF A CASE A 29-year-old man experienced a sudden onset of severe lower-back pain and a feeling of weakness in both thighs during yoga exercise on Jan 31, 1976. Several hours later neck pain with stiffness, headache, and a temperature of 39 °C appeared and progressed. He was admitted to a local