Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Streptococcus pneumoniae is a leading cause of bacterial meningitis with potential for severe neurological sequelae.
• Paroxysmal autonomic instability with dystonia (PAID) is a rare condition typically associated with traumatic brain injury or other CNS infections.
• Pneumococcal meningoencephalitis can lead to significant neurological impairment.

Purpose of the Study:

• To report the first known case of paroxysmal autonomic instability with dystonia (PAID) secondary to Streptococcus pneumoniae meningoencephalitis.
• To describe the clinical presentation and management of PAID in an infant.
• To highlight a novel association between pneumococcal infection and this autonomic disorder.

Main Methods:

• Case report of a seven-month-old infant.
• Clinical observation of neurological and autonomic symptoms including agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing.
• Diagnosis of paroxysmal autonomic instability with dystonia (PAID).
• Treatment with clonidine, baclofen, and benzodiazepines.

Main Results:

• The infant developed right basal ganglia and hypothalamic infarctions following Streptococcus pneumoniae meningoencephalitis.
• Daily episodes of severe autonomic dysfunction and dystonic posturing were observed.
• The patient showed a positive response to pharmacotherapy including clonidine, baclofen, and benzodiazepines.

Conclusions:

• This is the first reported case of paroxysmal autonomic instability with dystonia (PAID) associated with pneumococcal meningoencephalitis.
• The findings suggest that pneumococcal meningoencephalitis is a potential cause of PAID.
• Pharmacological management with clonidine, baclofen, and benzodiazepines can be effective in treating PAID.