Multifocal ischemic lesions and focal hematoma formation in a meningitis

ABSTRACT

Cerebrovascular complications are of the most frequent intracranial complications of bacterial meningitis. Most of the previous reports suggest that the prognosis for the pafients with cerebrovascular complications was unfavorable. We recently experienced a case of meningococcal meningitis with fulminant meningococcemia associated with multifocal non-enhancing lesions on, initial brain MRI. These lesions were hyperintense on T2weighted image and were located in left basal ganglia, both medial thalami, periventricular white matter, left cerebellar hemisphere, and right midbrain and were considered to be resulted from small vessel involvement. Gram negative diplococci were detected by Gram staining of specimens from skin lesion. After antimicrobial therapy and glucocorticoid replacement the patient was recovered without any neurologic sequelae. After one month, follow-up MRI showed resolution of all the ischemic lesions except in midbrain. Additionally there was a small focal hemtoma formation in left basal ganglia. The small hematoma was considered to be resulted from rupture of microaneurysm and disappeared on follow up MRI performed after 3 months. This case suggests that the cerebrovascular complications in meningococcal mningitis might be treated successfully.