A Case Report on Meningitis Complicated by Acute Ischemic Stroke and Failed Thrombolysis

Ischemic stroke is one of the rare but grave complications of meningitis with poor outcomes and long-term sequelae, and the role of thrombolysis with infection-related stroke remains uncertain. This case report documents a 52-year-old man presented with fever, headache, vomiting, and altered sensorium, and on examination he had neck rigidity. He was treated empirically for bacterial meningitis with antibiotics and dexamethasone, showing initial improvement. But on the 9th day of admission, he developed acute right upper motor neuron hemiparesis, dysarthria, and left-sided facial palsy. Urgent computed tomography (CT) of the brain showed no hemorrhage, and he was thrombolysed with alteplase within 120 min of symptom onset. Despite timely thrombolysis, there was no neurological recovery. Repeat brain CT confirmed acute ischemic stroke involving the left middle cerebral artery territory. Advanced imaging and endovascular thrombectomy were unavailable. He was managed conservatively with antiplatelets, statins, and physiotherapy, resulting in partial recovery on discharge. Stroke associated with meningitis presents both diagnostic and therapeutic challenges in resource-limited settings. Thrombolysis in such cases is controversial, and outcomes may be poor due to inflammatory thrombus burden. This case underscores the need for further research and highlights the limitations of stroke management, especially in resource-limited settings.