Cervicomedullary injury after pneumococcal meningitis with brain edema

RajaNandini Muralidharan, Alejandro Rabinstein, Eelco F M Wijdicks

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To demonstrate a rare but potential mechanism of quadriplegia in a patient with fulminant pneumococcal meningitis complicated by severe intracranial hypertension. Design: Case report. Setting: Intensive care unit. Patient: A 21-year-old man who presented with 3 days of headache, combativeness, and fever. Intervention: Antibiotics and steroids were initiated after lumbar puncture yielded purulent cerebrospinal fluid and streptococcus pneumoniae. Results: The patient's course was complicated by severe cerebral edema necessitating intracranial pressure monitoring and intracranial pressure-targeted therapy. Within 5 days he developed quadriplegia and areflexia. Brain and cervical spine magnetic resonance imaging revealed patchy areas of T2 signal hyperintensity with associated gadolinium enhancement in the superior cervical spinal cord, cerebellar tonsils, and medulla. Conclusions: Quadriplegia secondary to tonsillar herniation in fulminant meningitis is rare but should be considered in patients with acute quadriparesis after treatment of increased intracranial pressure. Magnetic resonance imaging signal changes and gadolinium enhancement may be demonstrated. Significant improvement of cord symptoms can be expected.

Original languageEnglish (US)
Pages (from-to)513-516
Number of pages4
JournalArchives of Neurology
Volume68
Issue number4
DOIs
StatePublished - Apr 1 2011

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Pneumococcal Meningitis
Quadriplegia
Brain Edema
Intracranial Pressure
Wounds and Injuries
Gadolinium
Magnetic Resonance Imaging
Encephalocele
Spinal Puncture
Intracranial Hypertension
Palatine Tonsil
Streptococcus pneumoniae
Meningitis
Headache
Intensive Care Units
Cerebrospinal Fluid
Spine
Fever
Steroids
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Cervicomedullary injury after pneumococcal meningitis with brain edema. / Muralidharan, RajaNandini; Rabinstein, Alejandro; Wijdicks, Eelco F M.

In: Archives of Neurology, Vol. 68, No. 4, 01.04.2011, p. 513-516.

Research output: Contribution to journalArticle

Muralidharan, RajaNandini ; Rabinstein, Alejandro ; Wijdicks, Eelco F M. / Cervicomedullary injury after pneumococcal meningitis with brain edema. In: Archives of Neurology. 2011 ; Vol. 68, No. 4. pp. 513-516.
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