Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults

Kastenbauer, Stefan; Winkler, Frank; Fesl, Gunther; Schiel, Xaver; Ostermann, Helmut; Yousry, Tarek; Pfister, H.-W.

doi:10.1001/archneur.58.5.806

Cited by 64 publications

(58 citation statements)

References 16 publications

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“…[7][8][9][10][11][12][13][14][15] Table 2 summarizes findings from previous case reports. Of note is the fact that S.aureus myelitis has been described even without contiguous spread (for example, ref 12).…”

Section: Staphylococcus Aureus Myelitis S Karakonstantis Et Almentioning

confidence: 99%

A rare case of acute transverse myelitis associated with Staphylococcus aureus bacteremia and osteomyelitis

Karakonstantis

Galani

Maragou

et al. 2017

Spinal Cord Ser Cases

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INTRODUCTION: Direct intramedullary infections are considered very rare. Only few reports of Staphylococcus aureus myelitis have been published. CASE PRESENTATION: Our patient, a 79-year-old male, presented with a 2-day history of high-grade fever and high inflammatory markers and progressively developed tetraplegia during hospitalization. Lumbar puncture revealed cerebrospinal fluid pleocytosis and a spinal cord MRI revealed transverse myelitis at the level of C3-C5 and possible osteomyelitis of C5-T1. Two blood cultures were positive for methicillin-sensitive S. aureus. Despite control of the infection, there was no neurologic improvement. DISCUSSION: The morbidity of infectious myelitis can be severe. Considering the rarity of S. aureus myelitis, experience gained from case reports is important. A brief review of the available literature is provided.

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Section: Staphylococcus Aureus Myelitis S Karakonstantis Et Almentioning

confidence: 99%

A rare case of acute transverse myelitis associated with Staphylococcus aureus bacteremia and osteomyelitis

Karakonstantis

Galani

Maragou

et al. 2017

Spinal Cord Ser Cases

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“…Emboli formation can be iatrogenic: embolic material to the spinal cord vasculature is reported in a pediatric patient undergoing sclerotherapy of esophageal varices [56]. Thrombotic vasculitis and/or occlusive arachnoiditis was implicated in cord infarction of many children with central nervous system infections [53,[57][58][59][60][61][62][63][64][65][66][67][68][69]. Several thrombotic disorders have been reported in cases of spinal cord infarction [70][71][72][73][74][75].…”

Section: Causes Of Spinal Cord Infarction In Childrenmentioning

confidence: 99%

“…4 Hypotension Cardiac arrest [29] 6 Cardiac tamponade [30] 1 Arteriovenous malformation Vascular steal [32] 1 Mechanism unknown [31] 5 Thrombotic disorders Prothrombin variant [70,71] 2 Protein S deficiency [75] 1 Primary antiphospholipid syndrome [72] 1 Systemic lupus erythematosis [17,77] 3 Infectious disease Bacterial meningitis [53,[57][58][59][60][61][62][63][64][65][66][67] 15 Amebic menigoencephalitis [69] 1 Viral encephalitis [68] 1 Cerebellar herniation Metabolic encephalopathy [50] 3 Minor trauma [41][42][43][44][45][46][47][48] 18 Fibrocartilaginous embolism [1][2][3][85][86][87][88][89] 10 Cancer Anterior spinal artery thrombosis [76] 1 Atlanto-axial instability Achondroplasia [22] 1 I-cell disease [20] 1 Iatrogenic Sclerotherapy of esophageal varices [56] 1 Prolonge...…”

mentioning

confidence: 99%

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Nance

Golomb

2007

Pediatric Neurology

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Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular inujury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult due to the small transverse area of the cord, cerebrospinal fluid artifact and inadequate resolution of MRI. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature which highlight the difficulties and controversies in the management of this condition.

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“…2 It is very rare for bacterial meningitis to be complicated by spinal cord dysfunction. 4 Reported mechanisms for spinal cord dysfunctions include infarction due to vasculitis, direct infection of the cord-and immune-mediated inflammatory myelopathy. [5][6][7] Choudhary et al 7 recently reviewed the literature and could locate only eight reported cases of meningococcal meningitis causing myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…The residual deficits of motor weakness, spasticity and sphincter disturbances are similar to other reported cases of thoracic myelopathy after meningococcal meningitis. 6 …”

Section: Discussionmentioning

confidence: 99%

Acute flaccid paraplegia: a rare complication of meningococcal meningitis

et al. 2007

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Study design: A case report of spinal cord dysfunction following meningococcal meningitis. Objectives: To describe a rare complication of meningococcal meningitis. Setting: Spinal Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. Methods: A young healthy male developed meningococcal meningitis followed by acute onset low thoracic flaccid paraplegia with complete motor and sensory loss and sphincter disturbance. He responded well to antibiotics but was not investigated for causes of paraplegia. While at home in a rural area, he developed pressure ulcers, anemia and depression. Magnetic resonance imaging of the whole spine and computed tomography scan of the brain performed after 4 and 10 weeks were normal. Results: The patient had a comprehensive rehabilitation at our institute. Recovery was complicated by ossification in the right thigh, which responded well to radiotherapy. At 1-year follow-up, the motor deficit and neurogenic bladder and bowel persisted and the patient remained wheelchair dependent for mobility. Conclusion: Several mechanisms have been proposed to explain spinal cord damage after meningitis. These include spinal cord infarction; autoimmune-mediated inflammatory myelopathy and direct infection of the cord. Most probable cause of spinal cord dysfunction in this case was thoracic myelopathy.

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Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults

Cited by 64 publications

References 16 publications

A rare case of acute transverse myelitis associated with Staphylococcus aureus bacteremia and osteomyelitis

A rare case of acute transverse myelitis associated with Staphylococcus aureus bacteremia and osteomyelitis

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Acute flaccid paraplegia: a rare complication of meningococcal meningitis

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