Chapter 2.4 - Bacterial Meningitis

Summary

Acute bacterial meningitis (ABM) is frequently complicated with cerebrovascular events (CE). Immunosuppression, cancer, otitis/sinusitis, diabetes mellitus and alcoholism are the main risk factors for ABM that was almost always fatal before antibiotic therapy introduction. Stroke has a incidence of 14% in patients with bacterial meningitis and, Streptocuccus Pneumoniae, is the most frequent isolated pathogen. Stroke-related infections, can be due both to septic emboli, and to the inflammatory status that induces plaque instability, narrowing of the vessel lumen and brain ischaemia. We discuss a case of a 76-year-old man with several vascular risk factors who was admitted to the neurology department for sudden onset of left hemiparesis and slurred speech with brain MRI evidence of a small acute ischemic infarct in the right temporal pole and ipsilateral multifocal middle cerebral artery (MCA) irregularity. Two months later because of change in gait with non-specific dizziness, a new subtle left hemiparesis and generalized epileptic seizures, MRI was repeated. The images demonstrated a well-formed rounded lesion with diffusion restriction, peripheral and meningeal enhancement and diffuse surrounding vasogenic edema, consistent with pyogenic abscess. Surgery confirmed abscess from Staphylococcus aureus. Dicloxacillin has been used, based on antibiogram results, and antiepileptic therapy with Levetiracetam 1500mg/daily was started. Two years after surgery, follow-up MRI showed no evidence of abscess with stable distal M1/M2 stenosis. Since stroke or stroke-like symptoms can hide meningitis, the presence of at least one of the classic triad signs (fever, neck stiffness and behavioral changes), can suggest ABM diagnosis