• William B Lo, Julian Cahill, Martyn Carey, Hiten Mehta, and Amjad Shad.
• Department of Neurosurgery, University Hospital, Coventry, United Kingdom. Electronic address: williamlo@doctors.org.uk.
• World Neurosurg. 2014 Mar 1;81(3-4):651.e9-13.

ObjectiveInfection associated with an intracranial meningioma is an extremely rare condition. Only six cases have been described in the literature. Because of its dual pathologies, initial radiologic diagnosis can be difficult. We present the first reported case of multiple infected intracranial meningiomas and correlate the radiologic and histologic findings.MethodsA 70-year-old woman presented with sepsis and a left hemiparesis following ureteroscopy and lithotripsy. A large right parietal lesion and a smaller left frontal lesion were diagnosed on magnetic resonance imaging. Diffusion-weighted imaging and an apparent diffusion coefficient map demonstrated features of cerebral metastases.ResultsA 2-stage excision confirmed atypical meningiomas containing an intratumoral abscess secondary to Escherichia coli. The patient made a full neurologic recovery. Despite the additional techniques, the radiologic diagnosis was initially challenging because of the dual pathologies. Nonetheless, the radiologic appearance was consistent with the complex histologic findings.ConclusionsIn the appropriate clinical context, diffusion-weighted imaging and apparent diffusion coefficient map aid the diagnosis of infected intracranial meningiomas.Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

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