Intraspinal Dermoid Tumor Presenting as Chemical Meningitis

Abstract

History. A 6-year-old girl entered the Mount Sinai IIospital in October, 1965, because of fever, headaches, and difficulty with urination. Two weeks prior to admission she fell from her bicycle, landing in a semi-sitting position. The next day she complained of headaches and abdominal pain. A few days later she developed fever, vomiting, photophobia, and neck stiffness, which persisted despite oral penicillin therapy. She was then hospitalized elsewhere where the past history revealed enuresis unchanged since infancy and increasing urgency and frequency of urination for the past 2 years. A lumbar puncture at that time revealed normal spinal fluid pressure and 1400 cells/ram 3, 70(~0 of which were polymorphonuelear leukoeytes. A few gram negative diploeoeei were seen on smear, but culture showed no growth in 7~ hours. Although the patient was treated with adequate doses of intravenous antibiotics, she continued to run a febrile course with temperatures varying from 10~ ~ to 104~ She subsequently developed urinary retention which necessitated insertion of an indwelling urethral catheter. Because of persistent temperature elevation, a second lumbar puncture was performed. Grossly purulent fluid was obtained at the L4-5 interspace, while freely flowing clear eerebrospinal fluid was obtained by puncture at L~-3. Smear and culture of both specimens were negative. Examination. At the time of her transfer to the Mount Sinai Hospital, the patient was pale, apprehensive, and in moderate distress. The temperature was 10S~ The general