Cerebral Arteritis With Extremely Late Onset Secondary to Bacterial Meningitis -Case Report-

Abstract

A 59-year-old woman presented with bacterial meningitis causing arterial narrowing in the very late stage. She initially underwent transsphenoidal surgery for massive non-functioning pituitary adenoma resulting in gross total removal. The postoperative course was uneventful, and she was discharged 12 days after surgery. Fourteen months later, she presented with bacterial meningitis due to streptococcus. Administration of multiple antibiotics resulted in normalization of cerebrospinal fluid findings. Forty days after meningitis onset, she suddenly suffered motor weakness of the right extremities. Magnetic resonance (MR) angiography revealed multiple intracranial arterial narrowings. Despite intensive treatment, no improvement of arterial narrowing was seen, and she suffered cerebral infarction. Six months after the onset of meningitis, MR angiography still showed multiple arterial narrowings, and MR plaque imaging of the stenotic vessel disclosed thickened arterial wall. This case illustrates the complex time course of arteritis caused by severe bacterial meningitis, and the intractability to treatment.

Intra-arterial Injection of Fasudil Hydrochloride for Cerebral Vasospasm Secondary to Bacterial Meningitis

“…Despite improvements in antimicrobial therapy, bacterial meningitis still has clinically significant morbidity and mortality. 2 , 3) The clinical outcomes of bacterial meningitis are often affected by intracranial consequences, such as cerebral edema, hydrocephalus, and cerebrovascular complications. 2 , 4) Cerebrovascular complications are common, but severe cerebral vasospasm that causes ischemic injury is rarely reported.…”

“… 2 , 3) The clinical outcomes of bacterial meningitis are often affected by intracranial consequences, such as cerebral edema, hydrocephalus, and cerebrovascular complications. 2 , 4) Cerebrovascular complications are common, but severe cerebral vasospasm that causes ischemic injury is rarely reported. 5) Conversely, postmortem histopathological evaluation of patients who died of acute bacterial meningitis suggests that the occurrence of cerebral vasospasm is more frequent than reported.…”

“…Conversely, vasospasm associated with meningitis is relatively rare and treatment strategies are not well known. 2) Hypervolemia, hypertension, and hemodilution (triple H) therapy can prevent ischemic deficit after cerebral vasospasm associated with meningitis but it is not always effective. 10) Triple H therapy may also be harmful to patients because of the risk of cerebral hemorrhage in central nervous system infections.…”