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[Bacterial cerebritis developed from purulent meningitis--serial CT and MRI study of a case]
Abstract:
A 54-year-old woman was admitted to our hospital because of purulent meningitis caused by Streptococcus pneumoniae during a long-term administration of prednisolone for the treatment of bronchial asthma. After admission, both antibiotics and steroids were given, which resulted in her good general and neurological condition, and the normal protein and glucose content in her cerebrospinal fluid three weeks later. However, post-contrast computerized tomography (CT) at this time showed various size of multiple irregular high-densities devoid of capsular component in the white matter of the bilateral cerebral hemisphere. MRI examination revealed that the lesions were of low intensity on the T1-weighted sequence whereas high on T2-weighted sequence. Gd-DTPA enhanced the T1-weighted images on these lesions. These findings may indicate that the lesions were at the pre-encapsulation stage of cerebritis, because the lesions were gradually reduced and disappeared after the subsequent antibiotic therapy. It is emphasized that patients with purulent meningitis under steroid therapy require careful observation for the risk of bacterial cerebritis.
Insights
A woman on long-term steroid therapy for asthma developed pneumococcal meningitis. Imaging revealed early cerebritis lesions, highlighting the need for careful monitoring in such patients.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- A 54-year-old woman with a history of bronchial asthma, treated with long-term prednisolone, presented with purulent meningitis.
- The causative agent was identified as Streptococcus pneumoniae.
Observation:
- Despite combined antibiotic and steroid treatment, leading to clinical improvement and normalization of cerebrospinal fluid parameters, advanced imaging revealed abnormalities.
- Post-contrast computerized tomography (CT) demonstrated multiple, irregular, high-density lesions in the bilateral cerebral white matter.
- Magnetic Resonance Imaging (MRI) showed these lesions as T1-hypointense and T2-hyperintense, with enhancement after Gd-DTPA administration.
Findings:
- The imaging characteristics suggest lesions in the pre-encapsulation stage of bacterial cerebritis.
- These lesions showed a progressive reduction and eventual disappearance following continued antibiotic therapy.
Implications:
- Patients with purulent meningitis undergoing concurrent steroid therapy are at increased risk for developing bacterial cerebritis.
- Close radiological and clinical monitoring is crucial for early detection and management of cerebritis in immunocompromised patients.