Coma in fulminant pneumococcal meningitis: New MRI observations

Abstract

We report a 45-year-old man with fulminant pneumococcal meningitis. Fluid attenuated inverse ratio MR images showed the ravaging consequences of occlusive vasculopathy and a transient purulent basal exudate. Bilateral thalamic lesions may have explained the failure to awaken despite appropriate antibiotic therapy.

Fulminant Cytotoxic Edema in a Patient with Pneumococcal Meningoencephalitis

“…The detection of focal areas of subarachnoid hemorrhage as well as ischemic lesions in the course of lenticulostriate arteries along the external and internal capsule add to the clinical picture. Symmetrical ischemic lesions due to vasculitis involving the internal capsule were also observed by Vernino et al2 However, the extensive white-matter lesions with a confluent lesion pattern and sparing of the cortex observed in our patient greatly exceed focal ischemia caused by vasculitis. Few case reports have referred to widespread white-matter lesions in pneumococcal meningitis, instead being limited either to confluent lesions of the deep white matter3 or to symmetrical lesions predominantly of the frontal white matter 4.…”

A case of fulminant pneumococcus meningoencephalitis progressing with white matter involvement despite two doses of conjugated pneumococcus vaccine

“…7 The other three described cases are adults. [14][15][16] The clinical course of the 4-monthold infant was fulminant and necrosis was seen in bilateral basal ganglions in the autopsy performed after death. 7 There was basal ganglion involvement in one case reported in the literature and white matter involvement in another.…”

Retroperitoneal infection complicated by bacterial meningitis and ventriculitis with secondary brainstem infarction

“…Abnormal hyperintensity in the subarachnoid space on FLAIR sequences and leptomeningeal enhancement on T1-gadolinium sequences has been described in meningitis [11]. Parenchymal FLAIR hyperintensity has also been described [12]. Others have reported DWI hyperintensity inside abscesses and infectious collections [13], including the ventricles [14].…”