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[A case of peptostreptococcal meningitis associated with subarachnoid hemorrhage and subdural hematoma]
Abstract:
A very rare case of peptostreptococcal meningitis associated with subarachnoid hemorrhage and subdural hematoma was reported. A 25-year-old man was admitted to St. Mary's Hospital on November 6, 1984 with a few day's history of headache and low grade fever. On admission, he had high grade fever (39.2 degrees C) and tachycardia (110/min). There were no neurological deficits other than neck stiffness and Kernig's sign. The cerebrospinal fluid (CSF) which was obtained through lumbar puncture showed watery clear appearance, white cell count of 32/3 mm3 (mononuclear: polymorphonuclear = 4:5), protein 76 mg/dl and glucose 8 mg/dl. It was found to be sterile. However, peptostreptococcus was found in his peripheral blood culture. He was diagnosed peptostreptococcal meningitis. After administration of antibiotics, laboratory test result of CSF improved gradually so as his meningeal irritation signs. After 25 days of hospitalization, he developed suddenly severe headache. CSF showed bloody and xanthochromic appearance, and CT scan revealed a subdural hematoma in the left fronto-temporal convexity. Although we suspected formation of mycotic aneurysm caused by the meningitis and its rupture, cerebral angiography revealed no abnormality except for the findings of subdural hematoma. The subdural hematoma was completely absorbed and he was discharged 79 days after admission without having any neurological deficit. We concluded that such a mycotic aneurysm was too small to be detected by the cerebral angiography.
Insights
This case report details a rare instance of peptostreptococcal meningitis leading to subarachnoid hemorrhage and subdural hematoma. Prompt antibiotic treatment improved the patient
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Peptostreptococcal meningitis is a rare bacterial infection of the central nervous system.
- Subarachnoid hemorrhage and subdural hematoma are serious complications that can arise from meningitis.
Observation:
- A 25-year-old male presented with symptoms of meningitis, including fever and neck stiffness.
- Cerebrospinal fluid analysis initially suggested meningitis but was sterile; however, peripheral blood cultures identified Peptostreptococcus.
- The patient later developed a subdural hematoma, suspected to be from a ruptured mycotic aneurysm, though angiography was inconclusive.
Findings:
- Successful treatment of peptostreptococcal meningitis with antibiotics led to gradual improvement.
- A subdural hematoma developed despite initial treatment, resolving completely over time.
- Cerebral angiography did not reveal a mycotic aneurysm, suggesting it was too small to detect.
Implications:
- This case highlights the importance of considering rare bacterial pathogens in meningitis.
- It underscores the potential for serious vascular complications like subdural hematomas in meningitis patients.
- The case suggests that small mycotic aneurysms may not be detectable by standard angiography.