Childhood pneumococcal meningitis: may it begin with diarrhea and proceed with cerebral infarct.

Pneumococcal meningitis does continue to be an important cause of mortality and morbidity in childhood despite widespread vaccination. It develops thorough invasion of the meninges by the agent via bloodstream. It may manifest typical signs of meningeal irritation and even the symptoms not belonging to the central nervous system, such as diarrhea. The diagnosis is made by microscopic evaluation and culture of cerebrospinal fluid (CSF) obtained by lumbar puncture. Despite the treatment, the risk of occurrence of cerebral and neurologic complications is high. A two-month old baby girl was presented to our outpatients’ clinic because of fever and diarrhea; she was diagnosed with pneumococcal meningitis and developed cerebral infarct during surveillance. The reason why we presented this patient is to highlight that meningitis due to pneumococ, one of the most common causing agents in childhood meningitis, may have clinical presentations other than expected.

Encephalomyelopathy in a child with acute lymphoblastic leukemia who had received radiotherapy and intrathecal chemotherapy.

Encephalomyelopathy is a rare complication of chemotherapy and radiotherapy , and it is a serious cause of morbidity and mortality in the children with Acute Lymphoblastic Leukemia (ALL). A fifteen years old girl, who was diagnosed with ALL 3 years ago, developed CNS relapse 2 years after diagnosis and undertook CNS relapse protocol ( 2400 cGy cranial + 1500 cGy spinal radiotherapy, meanwhile intrathecal chemotherapy with MTX + ARA-C + Prednisone 5 times). Eight months later from radiotherapy, firstly right hemiparesy consequently quadriplegia and quadriparestesia developed, stool and urine incontinence occured, respiration problems started and progressively increased, so she exitus due to respiration deficiency.