The right diagnosis but the wrong pathway? Listeria meningitis mimicking stroke

Karunaratne, Kushan; Bertoni, Miguel; Balogun, Ibrahim; Hargroves, David; Webb, Tom

doi:10.1136/practneurol-2014-001021

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…Anamnestic data, sophisticated neurological examination, presence of febrile and blood test results usually help to identificate mimics, but it can be very difficult in the minority of cases [96].…”

Section: Discussionmentioning

confidence: 99%

Ischemic stroke mimics: A comprehensive review

Pohl

Hesszenberger

Kapus

et al. 2021

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Ischemic stroke mimics: A comprehensive review

Pohl

Hesszenberger

Kapus

et al. 2021

Journal of Clinical Neuroscience

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“…Sixty percent occur within 24 h and it is possible that 40% of all seizures are presented at the onset of stroke symptoms raising the possibility of other etiology, requiring an extensive diagnostic workup. 38,40,98 Aphasic SE or postictal confusion with paresis is indistinguishable from IS in patients with dementia or aphasia. 68 EEG is not routinely available in the emergency rooms and the procedure takes time causing significant delay in acute stroke treatment.…”

Section: Discussionmentioning

confidence: 99%

“…ES tends to be focal (more likely simplex partial than complex partial) at onset in about two-thirds of all patients and general in the remaining one-third. Sixty percent occur within 24 h and it is possible that 40% of all seizures are presented at the onset of stroke symptoms raising the possibility of other etiology, requiring an extensive diagnostic workup 38 , 40 , 98 . Aphasic SE or postictal confusion with paresis is indistinguishable from IS in patients with dementia or aphasia 68 …”

Section: Discussionmentioning

confidence: 99%

Early seizures after ischemic stroke: focus on thrombolysis

et al. 2019

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Introduction.Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS.Aim.We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.Results.We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES.Conclusion.ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.

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Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

Deen

Boyes²,

Oyewole³

et al. 2020

BJR|case reports

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Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn’s disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.

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The right diagnosis but the wrong pathway? Listeria meningitis mimicking stroke

Cited by 4 publications

References 2 publications

Ischemic stroke mimics: A comprehensive review

Ischemic stroke mimics: A comprehensive review

Early seizures after ischemic stroke: focus on thrombolysis

Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

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