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Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis
S Kastenbauer1, F Winkler, G Fesl
1Department of Neurology, Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany.
Background:
Bacterial meningitis is rarely complicated by acute spinal cord involvement (eg, myelitis, ischemic infarction, spinal abscess, or epidural hemorrhage). In spinal cord dysfunction, magnetic resonance imaging (MRI) is the imaging modality of choice. Still, MRI findings of myelitis due to bacterial meningitis in adults have not been reported.
Methods:
Spinal MRIs were obtained during the acute stage of meningitis and on follow-up in 3 adults with bacterial meningitis that was complicated by paraparesis or tetraparesis and bowel and bladder incontinence. The causative pathogens were Streptococcus pneumoniae and Neisseria meningitidis; in 1 patient, the pathogen was not identified.
Results:
In all cases, spinal MRI ruled out a compression of the cord by an extramedullary mass but demonstrated hyperintensities on T2-weighted images that predominantly involved the gray matter and extended from the cervical to the lumbar cord. Leptomeningeal and discrete nodular intramedullary enhancement on T1-weighted images was detected only in 1 patient. Follow-up examinations revealed that hyperintensities resolved completely in 1 patient, while a central cavitation developed in the cervical spinal cord of another, and the MRI findings were progressive during the first 4 weeks in the third patient. In all cases, severe paresis and bowel and bladder incontinence persisted.
Conclusion:
We demonstrate for the first time the MRI findings of adults with acute spinal cord involvement during bacterial meningitis. Magnetic resonance imaging showed central intramedullary hyperintensities on T2-weighted images that extended from the cervical to the lumbar cord, indicating myelitis. Clinical follow-up examinations suggest that myelitis during bacterial meningitis has an unfavorable prognosis.
Insights
Bacterial meningitis rarely affects the spinal cord. This study details MRI findings of myelitis in adults, showing T2 hyperintensities and an unfavorable prognosis for spinal cord involvement.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Bacterial meningitis rarely involves the spinal cord, with limited reported cases of myelitis.
- Magnetic resonance imaging (MRI) is crucial for evaluating spinal cord dysfunction.
Observation:
- Three adult patients with bacterial meningitis and spinal cord dysfunction underwent spinal MRI.
- Causative pathogens included Streptococcus pneumoniae and Neisseria meningitidis.
Findings:
- Spinal MRI revealed T2-weighted hyperintensities predominantly in the gray matter, extending from cervical to lumbar regions.
- No extramedullary compression was observed; leptomeningeal and intramedullary enhancement were noted in one patient.
- Follow-up MRI showed resolution in one, cavitation in another, and progression in a third patient.
Implications:
- This study presents the first reported MRI findings of adult myelitis secondary to bacterial meningitis.
- Findings indicate myelitis during bacterial meningitis has a poor prognosis, with persistent neurological deficits.