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Pneumococcal meningitis masquerading as subarachnoid haemorrhage

Taposh Chatterjee1, John R Gowardman, Tony D Goh

  • 1Intensive Care Unit, Canberra Hospital, Woden, ACT 2605, Australia.

The Medical Journal of Australia
|May 14, 2003
PubMed

Insights

Pneumococcal meningitis can mimic subarachnoid hemorrhage and stroke, leading to misdiagnosis. Prompt lumbar puncture is crucial for identifying infectious causes like Streptococcus pneumoniae, even with initial imaging suggesting other conditions.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Warfarin is an anticoagulant used for venous thrombosis.
  • Subarachnoid hemorrhage and cerebral infarcts are serious neurological conditions.
  • Meningitis is an inflammation of the membranes surrounding the brain and spinal cord.

Observation:

  • A 43-year-old woman on warfarin presented with flu-like symptoms and decreased consciousness.
  • Initial imaging (CT and MRI) suggested subarachnoid hemorrhage and widespread cerebral infarcts.
  • Neurological findings appeared disproportionate to the observed hemorrhage.

Findings:

  • Lumbar puncture revealed meningitis caused by Streptococcus pneumoniae.
  • The patient's symptoms and imaging findings were ultimately attributed to bacterial meningitis.

Implications:

  • Bacterial meningitis can present with neurological signs mimicking cerebrovascular events.
  • Early diagnosis of meningitis is critical for appropriate treatment and improved outcomes.
  • Lumbar puncture remains essential for diagnosing meningitis, especially when imaging is inconclusive or atypical.

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