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

Willey, Joshua Z.; DeLaPaz, Robert L.

doi:10.1007/s12028-007-0009-9

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…The pus in his subarachnoid space likely evoked a small-vessel vasculitis at first, and then gradually infarcted larger, more vital areas of his brainstem and cerebellum in a massive large-vessel vertebral-basilar meningo-vasculitis. Cerebral vasculitis of any cause has a predilection for the larger-sized vasculature [4,5,6] but as seen in figure 4c, on gross examination the patient's basilar artery, posterior cerebral arteries and cerebellar arteries were mostly patent. However, figure 4d shows that on high-power light microscopy, moderate-to-severe fibrointimal proliferation was seen with variable arteritis, partial large-vessel occlusion and subtotal small-vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

Rose

Parra‐Herran²,

Petito³

et al. 2010

Case Rep Neurol

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Extra-axial restriction on diffusion weighted imaging (DWI) is an unusual finding on brain magnetic resonance imaging (MRI). Intra-axial restriction on DWI, however, is common, and can represent brain parenchymal infarction, tumor, abscess, or toxic-metabolic process. The infrequency of extra-axial DWI restriction and the paucity of clinico-pathological correlation in the literature limit its differential diagnosis. Scant case reports suggest that extra-axial DWI restriction could be a lymphoma, neurenteric cyst, or, in one patient, subdural empyema [1–3]. We postulate that pus formation must be excluded first, because it can provoke an aggressive meningo-vasculitis with rapidly fatal, intra-axial infarctions. Our patient was a 45-year-old man, presenting to our hospital with left facial droop and right (contralateral) arm and leg weakness. Initial MRI revealed DWI restriction in the left lateral pons, consistent with a classic Millard-Gubler stroke. Also noted was a subtle, extra-axial area of curvilinear diffusion restriction in the left cerebellar-pontine angle’s subarachnoid space. Days later, the patient had a headache, and repeat MRI revealed extension of the two DWI lesions – both the intra-axial pontine infarction and the extra-axial area of restricted diffusion in the subarachnoid space. The patient became comatose, a third MRI revealed more extensive DWI restrictions, and he expired despite aggressive care. Autopsy revealed massive brainstem infarcts, a thick lymphoplasmacytic infiltrate, copious Gram-Positive cocci (likely MRSA) and arteries partially occluded with fibrointimal proliferation. This emphasizes the concept that extra-axial DWI restriction can represent pus development in the subarachnoid space – a radiographic marker to identify a patient at risk for demise due to septic, meningo-vasculitic infarctions.

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Section: Discussionmentioning

confidence: 99%

Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

Rose

Parra‐Herran²,

Petito³

et al. 2010

Case Rep Neurol

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“…Many similar studies have proven that cerebral infarctions do occur as a complication in a significant proportion of patients with ABM [ 11 ]. Instances where such ischemic strokes occurring in the brainstem though rare are reported in the literature [ 12 – 14 ]. The patient had significant atrophy of the tongue.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Hypoglossal Nerve Palsy due to Brainstem Infarction: A Rare Presentation of Presumed Pyogenic Meningitis

Kariyawasam

Fonseka

Singhapura

et al. 2018

Case Reports in Neurological Medicine

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Background Cranial nerve palsies are well-known complications of basal meningitis, especially in patients with tuberculous meningitis. However, a minority of bacterial meningitis gets complicated with cranial nerve palsies. Although cerebral infarctions are known to occur with acute bacterial meningitis, infarctions occurring in the brainstem are infrequently described. Case Presentation We report a 46-year-old healthy female who presented with dysarthria with fever, headache, and vomiting and was diagnosed to have acute pyogenic meningitis complicated with a brainstem infarction resulting in bilateral hypoglossal palsy. Her MRI revealed an infarction in the lower part of the medulla oblongata, probably involving the bilateral hypoglossal nuclei. Conclusion Isolated bilateral hypoglossal nerve palsy is an extremely rare cranial nerve palsy, secondary to pyogenic meningitis. To our knowledge, this should be the first reported case of isolated bilateral hypoglossal nerve palsy due to a brainstem infarct in the background of pyogenic meningitis.

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Current understanding of infection of the ventricles and its complications

Allos,

Hasbun

2024

Expert Review of Anti-infective Therapy

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

Abstract: We present a case where a comatose patient with a known retroperitoneal abscess was diagnosed via Magnetic Resonance Imaging (MRI) with extensive brainstem infarction secondary to basilar meningitis.

Cited by 4 publications

References 14 publications

Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

Restricted Diffusion of Pus in the Subarachnoid Space: MRSA Meningo-Vasculitis and Progressive Brainstem Ischemic Strokes – A Case Report

Bilateral Hypoglossal Nerve Palsy due to Brainstem Infarction: A Rare Presentation of Presumed Pyogenic Meningitis

Current understanding of infection of the ventricles and its complications

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