Late-developing cerebral arteropathy after pyogenic meningitis

BACKGROUND: Although vasculopathy is a recognized complication during acute meningitis, to our knowledge, no previous reports have been published of this phenomenon developing months after successful treatment. OBJECTIVE: To report a unique case of a late-developing vasculopathy after pyogenic meningitis in an adult. REPORT OF A CASE: A 51-year-old woman was seen with severe headache 2 months after treatment of Haemophilus influenzae type C meningitis. Initial arteriography showed no abnormality; a second arteriogram showed progressive multifocal intracranial stenosis affecting mainly the internal carotid arteries. Findings from pathologic examination disclosed diffuse collagenosis consistent with chronic vascular injury from meningitis. The arterial lesions stabilized, and the patient remained asymptomatic. CONCLUSION: Progressive intracranial arterial stenosis can evolve months after meningitis and should be added to the list of recognized vascular complications.     

The probable role of hydrocephalus in the development of intraventricular septa

Multiloculated cerebral ventricles are a well-known complication of neonatal meningitis secondary to gram-negative bacteria. Their presence often hampers the proper functioning of the multiple shunts required for draining the ventricles. To determine whether the associated hydrocephalus may contribute to the development of the ventricular septa, we analyzed the histological structure of the ventricular wall and of the ventricular septa of a child who died as a consequence of Escherichia coli meningitis and unilateral hydrocephalus. Our results show that the ventricular septa are formed by glial protrusion into the ventricles. The ependymal wall of the grossly dilated ventricle was disrupted, but not that of the contralateral ventricle. We hypothesize that the presence of an insufficiently controlled hydrocephalus may have been one of the factors that induced the formation of the septa. It is suggested that an external ventricular derivation should be used during the active phase of the infection.     

Irreversible papillitis and ophthalmoparesis as a presenting manifestation of neurobrucellosis

A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.     

Syringomyelia and intradural extramedullary tuberculoma of the spinal cord as a late complication of tuberculous meningitis

Intradural extramedullary (IDEM) tuberculomas account for only 1% of all spinal tuberculomas. Concurrent IDEM tuberculoma and syringomyelia arising as a complication of tuberculous meningitis (TM) is extremely rare and only two cases have been reported to date. There is yet no report in the literature describing syringomyelia presenting as a delayed complication of IDEM tuberculoma. Here we present such a case. A 21 year-old male patient underwent partial decompression for thoracolumbar IDEM tuberculoma as a late complication of tuberculous meningitis. Spinal magnetic resonance imaging (MRI) of the patient suffering from progression of paraparesia six months after the operation revealed a syringomyelia occupying the space from T1 to T9, remote from the operation site, and syringo-peritoneal shunt placement was performed.     

Severe symptomatic aseptic chemical meningitis following myelography: the role of procalcitonin

Symptomatic aseptic, chemical meningitis is a rare complication of myelography. Its acute clinical course and standard laboratory findings are indistinguishable from those of bacterial meningitis. The authors present a case of severe postmyelographic chemical meningitis and compare CSF and serum inflammatory markers to a group of seven patients with proven bacterial meningitis. As in viral meningitis, procalcitonin might be able to discriminate between bacterial and chemical causes of CNS inflammation.     

The Incidence of Meningitis in Patients with Traumatic Brain Injury Undergoing External Ventricular Drain Placement: A Nationwide Inpatient Sample Analysis

Neurocritical Care - Infection is the most common complication of external ventricular drain (EVD) placement. National trends in the annual incidence of meningitis among patients with traumatic...     

Fatal Subdural Empyema Following Pyogenic Meningitis

Subdural empyema is a rare form of intracranial sepsis associated with high morbidity and mortality. The most frequent cause is extension of paranasal sinusitis through emissary veins or of mastoiditis through the mucosa, bone, and dura mater. Development of subdural empyema after pyogenic meningitis is known to be very unusual in adults. We report a rare case of fatal subdural empyema, an unusual complication of pyogenic meningitis. Our bitter experience suggests that subdural empyema should be borne in mind in patient with pyogenic meningitis who exhibit neurological deterioration.     

Intraventricular meningitis as a complication of purulent meningitis. A case report

Report of a case of intraventricular hematoma as purulent meningitis complication in a child of 6 months old, without vascular malformation. The evolution was satisfactory after the surgical treatment.     

Mycoplasma meningitis resulting in increased production of cerebrospinal fluid: case report and review of the literature

PURPOSE: We report a case of increased cerebrospinal fluid (CSF) production in a child with concomitant mycoplasma meningitis. MATERIALS AND METHODS: This 4-year-old boy presented with a 2-week history of body aches, malaise, and headaches. He developed sudden onset of obtundation, apnea, left eye deviation, and bilateral dilated and unreactive pupils. A ventriculostomy was placed initially for a poor neurologic examination in the setting of likely meningitis. Initial intracranial pressure was high, and CSF production was supraphysiologic for the first few days of empiric, broad-spectrum treatment. Mycoplasma meningitis was diagnosed. The ventriculostomy was weaned after adequate treatment for mycoplasma meningitis. RESULTS AND CONCLUSIONS: At 4 months follow-up, the child remains shunt-free with only mild cognitive-linguistic impairment. Untreated mycoplasma meningitis may cause raised intracranial pressure (possibly as a result of increased CSF production) and result in a poor neurological examination. In this setting, CSF diversion in the form of an external ventricular drain may be beneficial to preserve neurologic function during treatment with antibiotics.     

Persisting vasculitis after pneumococcal meningitis

Introduction  Bacterial meningitis is associated with a high mortality and a high incidence of neurological sequelae. Parainfectious vasculitis leading to ischemic brain damage is a known complication of bacterial meningitis but its treatment is uncertain. Methods and Results  We report the case of a 53-year-old man with pneumococcal meningitis who developed numerous ischemic lesions in the brainstem and basal ganglia caused by parainfectious vasculitis. Clinical and radiological improvement was observed after delayed corticosteroid initiation. Symptomatic vasculitis relapsed after steroid withdrawal and stabilized after reintroduction of the immunosuppressive therapy. Although the cerebrospinal fluid (CSF) contained high levels of MMP-9 at the time of symptomatic vasculitis, a significant decrease of the enzyme accompanied the introduction of corticotherapy and the regression of vasculitic symptoms. No relation between the level of MMP-9 and the white blood cell count in CSF could be found. Conclusion  Parainfectious vasculitis may respond to late corticosteroid treatment. MMP-9 level in CSF may be a marker of vasculitic complication in bacterial meningitis.     

Community-acquired <Emphasis Type="Italic">Pseudomonas</Emphasis> meningitis causes acute obstructive hydrocephalus

Introduction   Pseudomonas aeruginosa (PS) infection is serious in children and can cause malignant external otitis, endophthalmitis, endocarditis, meningitis, pneumonia, and septicemia (Huang et al. Pediatr Infect Dis J 1). The treatment of Pseudomonas infection requires prompt medical evaluation and appropriate antibiotic treatment. Case report  We report the case of a 6-month-old boy with an unusual presentation of acute obstructive hydrocephalus owing to Pseudomonas meningitis. Treatment with optimal antibiotic begun immediately after the pathogen was recognized and continued for 4 weeks. The patient received prompt surgical intervention for the complication of acute obstructive hydrocephalus. Conclusion  The early stage of obstructive hydrocephalus caused by community-acquired Pseudomonas is rare and should be immediately detected.     

Hemorrhagic tendency as a complication of Moxalactam therapy in bacterial meningitis

Moxalactam penetrates cerebral spinal fluid (CSF) and subdural fluid well enough to be a promising antimicrobial for enteric bacterial meningitis in neonates and infants. Clinical trials in adults and children have found few adverse effects. Prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) with or without bleeding was reported in adults. This paper reports this complication in two infants occurring at a time of clinical improvement following addition of Moxalactam to other antibiotics to which the meningitis had failed to respond. It is not certain if this complication was related to the underlying meningitis, the use of Moxalactam together with other antibiotics, or a combination of many factors. Further observation, close hemostatic monitoring, and timely vitamin K administration during its use are warranted.     

Aseptic meningitis after posterior fossa surgery treated by pseudomeningocele closure

Aseptic meningitis is a recognised complication after posterior fossa surgery. It is often self limiting but occasionally runs a protracted course requiring repeated CSF examination to exclude infection, and treatment with systemic steroids. A patient is described with aseptic meningitis after posterior fossa surgery who underwent posterior fossa re-exploration nearly 3 years after the initial operation. This disclosed a pseudomeningocele, which was closed. The patient remains symptom free almost 2 years after closure. In this case of chronic aseptic meningitis after posterior fossa surgery, closure of the pseudomeningocele found at exploratory surgery led to resolution of the symptoms.     

Postinfectious vasculopathy with evolution to moyamoya syndrome

BACKGROUND: Parainfectious vascular events are a known complication of bacterial meningitis, typically occurring within two weeks of disease onset. Delayed vascular complications are rare. We present a case of progressive vasculopathy following bacterial meningitis. CASE DESCRIPTION: A 20 year old woman developed progressive vasculopathy after successful treatment of pneumococcal meningitis. Within eight months of her infection, angiography revealed the appearance of moyamoya syndrome. Despite aggressive immunomodulation and anticoagulation, she had multiple strokes. Autopsy confirmed severe narrowing of proximal cerebral vasculature with absence of inflammation or atherosclerosis. CONCLUSIONS: The inflammation and subsequent postinfectious autoimmune response associated with meningitis can lead to a progressive vasculopathy and may represent a pathophysiologic mechanism for the arterial occlusions seen in moyamoya syndrome.     

Retroperitoneal infection complicated by bacterial meningitis and ventriculitis with secondary brainstem infarction

Introduction  

Retroperitoneal abscesses have been previously reported to cause infectious meningitis. Cerebral infarction is a known complication of basilar meningitis.     

Cerebral trunk abscess due to Neisseria meningitidis in a 28-year-old immunocompetent patient

Meningococcal disease can manifest in very different clinical situations. Meningococcal meningitis and fulminant meningococcemia (or purpura fulminans) are the most common forms of these infections, but many other manifestations can be seen including septic arthritis, pericarditis, pleurisy and conjunctivitis. Brain abscesses have also been described; they are a rare complication of meningococcal disease. We report the case of a 28-year-old immunocompetent patient who developed meningococcal infection associated with brain abscesses and oligo-arthritis.     

Intrathecal Baclofen Pump Infection With Meningitis: Effective Treatment by Radical Debridement and Intrareservoir Baclofen–Vancomycin Co-Infusion

ObjectivesIntrathecal baclofen pump associated central nervous system (CNS) infection and meningitis is a rare but serious complication and may have dire consequences. Due to bacterial biofilm formation, the optimal treatment strategy is usually for removal of the pump, followed by systemic antibiotics for treatment of local and CNS infection. We describe this case of a patient with recurrent Staphylococcus aureus pump site empyema and meningitis leading to status dystonicus, who was successfully managed with radical debridement and intrareservoir baclofen–vancomycin co-infusion.Materials and MethodsWe retrospectively report a case of infected intrathecal baclofen pump with meningitis and provide a full review of literature.ConclusionsTo the best of our knowledge, this is the first reported case of intrathecal baclofen (ITB)-associated pump site empyema and meningitis successfully treated with this technique. In selected cases where surgical explantation is deemed not feasible, this method can provide clinicians with an additional option for pump salvage and retention, while eradicating CNS infection and maintaining optimal control of spasticity and dystonia.     

Aseptic meningitis after transsphenoidal management of Rathke’s cleft cyst: case report and review of the literature

Aseptic meningitis after transsphenoidal surgery (TSS) for treatment of Rathke’s cleft cyst (RCC) is a rare complication caused by the leakage of the cyst contents within the subarachnoid space. We present a case of aseptic meningitis occurring after TSS for a RCC. During surgery, the cyst wall was subtotally removed, and intraoperative cerebrospinal fluid (CSF) leakage was observed. The patient developed meningeal signs and symptoms on the first postoperative day. CSF examinations were highly suggestive of aseptic meningitis. Histological examination confirmed a granulomatous inflammatory reaction of the RCC wall. Preexisting inflammation, subtotal cyst wall resection, intraoperative erosion of the diaphragma sellae and placement of a lumbar drain may be risk factors for the development of aseptic meningitis.     

Predictors of in-hospital shunt-dependent hydrocephalus following rupture of cerebral aneurysms

The development of shunt-dependent hydrocephalus is a well-recognised complication after aneurysmal subarachnoid haemorrhage, and negatively impacts on outcomes among survivors. This study aimed to identify early predictors of shunt dependency in a large administrative dataset of aneurysmal subarachnoid haemorrhage patients. We reviewed the National Hospital Morbidity Database in Australia for the years 1998 to 2008 and investigated the incidence of ventricular shunt placement following aneurysmal subarachnoid haemorrhage admissions. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictors of outcome. The following variables were considered: poor admission neurological grade; aneurysm location; intracerebral haemorrhage; intraventricular haemorrhage; acute hydrocephalus requiring the insertion of an external ventricular drain; surgical clipping; endovascular coiling; meningitis; and prolonged period of external ventricular drainage. A total of 10 807 patients hospitalised for aneurysmal subarachnoid haemorrhage were identified. Among them, 701 (6.5%) required a permanent cerebrospinal fluid diversion procedure during the same admission as the aneurysmal subarachnoid haemorrhage. On multivariate analysis, poor admission neurological grade, acute hydrocephalus, the presence of intraventricular haemorrhage, ruptured vertebral artery aneurysm, surgical clipping, endovascular coiling, meningitis, and a prolonged period of external ventricular drainage were significant predictors of shunt dependency. A patient with a ruptured middle cerebral artery aneurysm was unlikely to develop shunt dependency (odds ratio 0.58; 95% confidence interval 0.46–0.73; p < 0.001).     

Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complication of cerebral infection after TSS for pituitary macroadenoma.