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Parainfectious encephalomyeloradiculitis associated with bacterial meningitis: a case report
Yuji Kato1, Takeshi Hayashi2, Akira Uchino3
1Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan. yujik@saitama-med.ac.jp.
Introduction:
Acute disseminated encephalomyelitis in adulthood occurs in most cases after a viral infection. Acute disseminated encephalomyelitis associated with bacterial meningitis, however, is quite rare.
Case Presentation:
An 82-year-old Japanese woman presented with a fever and somnolence. Increased neutrophil count and protein content, and decreased glucose levels in her cerebrospinal fluid initially suggested bacterial meningitis. Brain magnetic resonance imaging on admission showed bilateral symmetrical lesions in her brainstem and her cerebellum. She was diagnosed with acute disseminated encephalomyelitis following bacterial meningitis. Even though appropriate antibiotic and steroid treatment improved her symptoms, she developed transverse myelitis and lumbosacral polyradiculitis on day 9.
Conclusions:
Parainfectious encephalomyeloradiculitis, a variant of acute disseminated encephalomyelitis, is a unique neurological syndrome that may be caused by bacterial infection in the central nervous system.
Insights
Acute disseminated encephalomyelitis (ADEM) is rare after bacterial meningitis. This case highlights ADEM presenting with transverse myelitis and polyradiculitis following bacterial meningitis in an adult.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Acute disseminated encephalomyelitis (ADEM) typically follows viral infections in adults.
- ADEM associated with bacterial meningitis is exceptionally rare.
Observation:
- An 82-year-old woman presented with fever and somnolence, initially suspected of bacterial meningitis due to cerebrospinal fluid analysis.
- Brain MRI revealed bilateral symmetrical lesions in the brainstem and cerebellum.
- The patient developed transverse myelitis and lumbosacral polyradiculitis on day 9 despite antibiotic and steroid treatment.
Findings:
- The patient was diagnosed with acute disseminated encephalomyelitis following bacterial meningitis.
- This case represents a rare instance of ADEM triggered by bacterial infection.
- The neurological presentation included encephalomyeloradiculitis, a variant of ADEM.
Implications:
- Bacterial central nervous system infections can precipitate parainfectious encephalomyeloradiculitis, a variant of ADEM.
- This case expands the understanding of ADEM's potential triggers and clinical manifestations.
- Early recognition and management are crucial for neurological recovery.
