"Unexplained" Delayed Death From Fungal Meningitis After Meningioma Resection

     R John Hurlbert, Juan M Bilbao and William S Tucker

Abstract:   Background: Progressive deterioration and ensuing death following a neurosurgical procedure often represents a diagnostic challenge to the team responsible for patient care. Many, but not all, causes are treatable if a diagnosis is made early. Methods: A 69-year-old woman who died 6 weeks postˆoperatively following a meningioma resection is reported. An initial routine postˆoperative course became complicated by progressive neurological deterioration 3ˆ4 weeks later. Despite extensive investigation she died 6 weeks postˆoperatively without a diagnosis. Results: Autopsy demonstrated extensive Candida meningitis. A review of the literature demonstrates this to be a reported complication in high risk patients, difficult to diagnose, but treatable when identified. Conclusions: Fungal meningitis should be high in the differential diagnosis in the postˆoperative patient with delayed, unexplained neurological deterioration, especially when associated with negative CSF cultures.

Can. J. Neurol. Sci. 1995; 22: 239-243