Post-operative Aseptic Meningitis of Adult Male After Left Parietal Craniotomy for GBM Resection: A Case Report
PM & R
Case Diagnosis: A 64-year-old male with Aseptic Meningitis following a craniotomy. Case Description: A 64-year-old male admitted for word-finding difficulty. At onset, patient could not recall information including his wife’s name. Head CT exhibited new brain mass in left temporal region with surrounding vasogenic edema. MRI of brain showed enhancing masses in left temporal (4.5cm) and right frontal lobe (1.5cm). Patient underwent left parietal supratentorial craniotomy resection of brain mass. Path report came back for grade IV GBM. Fifteen days after the craniotomy, patient developed severe bitemporal and occipital headaches that were not relieved by routine medications. Setting: Inpatient Rehabilitation Unit Assessment/Results: Head CT was ordered after the onset of the headaches. CT revealed a 4 mm hyperdense area of hemorrhage in the previous tumor bed of the left posterior temporal lobe. A repeat brain MRI
demonstrated improvement in the hemorrhage at the left parieto-occipital junction resection and mid-line shift. Neurology was consulted and diagnosed patient with post-operative aseptic meningitis (PAM) due to the area of hemorrhage. Patient started on IV solumedrol 100mg for five days with improvement of symptoms. Discussion: Headaches are common side effects post craniotomy. Advanced imaging is warranted with the onset of an intractable headache following a craniotomy. However, when imaging demonstrates improvement of the initial insult in the setting of clinical decline PAM should be considered. Lumbar puncture should be obtained in the setting of a new headache following a procedure to rule out bacterial meningitis. In this case a Lumbar puncture was not obtained. Conclusion: PAM should not be overlooked as a differential in patients with sudden onset headaches following a craniotomy without evidence of overt infection. Level of Evidence: Level V
Garelik L. Post-operative aseptic meningitis of adult male after left parietal craniotomy for GBM resection: a case report. 2021 Nov 19; PM & R 13(S1):S61.