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[Meningitis after myelography]
S H Bø1, K Nestvold, O Sortland
1Nevrologisk avdeling, Sentralsykehuset i Akershus, Nordbyhagen.
Abstract:
Lumbar myelography is still frequently used in cases of suspected lumbar radiculopathy. Since 1984, iohexol has been the contrast medium of choice in myelography, and so far only a few cases of chemical meningitis have been reported. Bacterial meningitis cannot be distinguished from chemical meningitis on the basis of clinical findings. A cerebrospinal fluid Gram stain and culture are the only truly reliable tests in deciding the etiology of the meningitis. We describe two patients who developed meningitis following myelography with iohexol. In one of the patients, the cerebrospinal fluid culture was positive with subsequent identification of Flavobacterium meningosepticum, a species not previously reported as an infectious agent in meningitis after myelography.
Insights
Two patients developed meningitis after lumbar myelography using iohexol contrast. One case involved Flavobacterium meningosepticum, a novel bacterial cause of meningitis following this diagnostic procedure.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Lumbar myelography is a common diagnostic tool for suspected lumbar radiculopathy.
- Iohexol has been the preferred contrast medium for myelography since 1984, with rare reports of chemical meningitis.
- Distinguishing bacterial from chemical meningitis solely on clinical presentation is challenging.
Observation:
- Two patients presented with meningitis symptoms subsequent to undergoing lumbar myelography with iohexol.
- Cerebrospinal fluid analysis was crucial for determining the cause of meningitis.
Findings:
- One patient's cerebrospinal fluid culture yielded Flavobacterium meningosepticum.
- This marks the first reported instance of Flavobacterium meningosepticum causing meningitis after myelography.
Implications:
- Highlights the potential for bacterial meningitis following iohexol myelography.
- Emphasizes the critical role of cerebrospinal fluid Gram stain and culture for accurate diagnosis.
- Suggests the need for vigilance regarding rare bacterial pathogens in post-myelography meningitis.