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Brainstem infarcts as an early manifestation of Streptococcus anginosus meningitis

Sung B Lee1, Lyell K Jones, Caterina Giannini

  • 1Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. lee.sung@mayo.edu

Neurocritical Care
|September 22, 2005
PubMed
Abstract

Insights

Streptococcus anginosus meningitis can cause early brainstem stroke. This rare complication, seen in a 58-year-old man with pontine infarcts, highlights the need for prompt diagnosis and treatment of bacterial meningitis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pathology

Background:

  • Bacterial meningitis commonly causes vasculitis and infarcts, but early large-vessel brainstem involvement is rare.
  • A previous case reported pontine infarcts in Streptococcus milleri meningitis.
  • This study details a case of brainstem infarction linked to Streptococcus anginosus meningitis.

Observation:

  • A 58-year-old man presented with gait instability and stupor.
  • Magnetic resonance imaging revealed bilateral pontine infarcts.
  • Cerebrospinal fluid analysis confirmed Streptococcus anginosus meningitis.

Findings:

  • The patient remained comatose despite antibiotic treatment, with postmortem examination revealing basal meningitis, ventriculitis, abscesses, and multiple brainstem infarcts.
  • Streptococcus anginosus, a common human flora, can cause invasive infections.
  • This meningitis type often affects the brain base, encasing the basilar artery and perforators.

Implications:

  • This case underscores the potential for Streptococcus anginosus to cause severe neurological complications, including early brainstem stroke.
  • Early recognition and aggressive management of meningitis caused by S. anginosus are crucial to prevent devastating neurological outcomes.
  • Further research into the specific mechanisms of vasculopathy caused by S. anginosus in meningitis is warranted.

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