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Neurolisteriosis presenting as recurrent transient ischemic attacks
R Staudinger1, D Levine, B Swaminathan
1Department of Neurology, New York University, NY 10016, USA.
Abstract:
An elderly man experienced recurrent transient episodes of right arm weakness and expressive aphasia. He was initially treated with aspirin and then with coumadin. Thirteen days after initial presentation, he became febrile and had signs of meningitis. The illness progressed relentlessly to death 9 weeks after admission to the hospital. Necropsy showed prominent meningitis with vasculitis extending into the left frontal lobe. Polymerase chain reaction identified the organism as Listeria monocytogenes.
Insights
A rare case of Listeria monocytogenes meningitis caused fatal vasculitis in an elderly man, presenting initially with stroke-like symptoms. Prompt diagnosis and treatment are crucial for this severe bacterial infection.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Listeria monocytogenes is a foodborne bacterium that can cause serious infections, particularly in vulnerable populations.
- Bacterial meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can lead to severe neurological complications.
Observation:
- An elderly male presented with transient ischemic attacks, including right arm weakness and expressive aphasia.
- The patient subsequently developed fever and signs of meningitis, progressing to death over 9 weeks.
- Necropsy revealed meningitis with vasculitis extending into the left frontal lobe.
Findings:
- Polymerase chain reaction (PCR) confirmed Listeria monocytogenes as the causative agent.
- The clinical presentation mimicked cerebrovascular events before the onset of meningitis.
- Vasculitis was a prominent pathological finding, indicating severe inflammation of blood vessels in the brain.
Implications:
- This case highlights the importance of considering infectious etiologies, such as Listeria meningitis, in elderly patients with recurrent neurological deficits.
- Early and accurate diagnosis of Listeria monocytogenes infection is critical for effective management and potentially improving patient outcomes.
- The study underscores the severe neurological consequences, including vasculitis, that can arise from untreated or refractory bacterial meningitis.