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Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings
Asumul K Bhojo1, Naveed Akhter, Rohit Bakshi
1Department of Neurology, The Aga Khan University, Karachi, Pakistan.
Abstract:
Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. Cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. Latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. Patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.
Insights
Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. This case highlights the importance of considering meningitis in patients with acute myelopathy and performing spinal MRI.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Neisseria meningitidis (meningococcal) meningitis is a serious infection.
- Spinal cord dysfunction is an uncommon but significant complication.
Observation:
- A 17-year-old presented with fever, headache, vomiting, and unresponsiveness, diagnosed with meningococcal meningitis.
- The patient developed progressive lower extremity weakness, areflexia, and extensor plantar responses.
- Cerebrospinal fluid analysis revealed polymorphonuclear pleocytosis and positive latex particle agglutination for meningococci.
Findings:
- Magnetic Resonance Imaging (MRI) demonstrated thoracic spinal cord hyperintensities (T4-T9) and four brain abscesses.
- The patient experienced persistent paraparesis despite recovery of brain function.
- Potential causes for myelopathy include vasculitis, stroke, autoimmune processes, or direct spinal cord infection.
Implications:
- This case underscores that myelopathy can complicate acute meningococcal meningitis.
- Spinal MRI is crucial for patients with myelopathy associated with acute meningitis.
- Clinicians should consider meningitis in the differential diagnosis of acute myelopathy.