title: Recurrent aseptic meningitis as a rare but important presentation of congenital petrous apex cholesteatoma: the value of appropriate imaging.
abstract: 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.
authors.affiliation: Department of Ear Nose and Throat Surgery, John Radcliffe Hospital, Oxford, UK.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: MacKeith
authors.forename: Maria
authors.initials: M
authors.lastname: Soledad-Juarez
authors.forename: Liliana
authors.initials: L
authors.lastname: Tiberti
authors.forename: Daniel
authors.initials: D
authors.lastname: Orfila
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D002781:Cholesteatoma / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008582:Meningitis, Aseptic / Q000209:etiology*; D010579:Petrous Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D012008:Recurrence; D014057:Tomography, X-Ray Computed