ABSTRACT
Fatality rates and the number of patients suffering from the after sequelae of bacterial meningitis have still remained high despite the development of new antibiotics. Cerebrovascular complications have been reported less frequently in adult cases than in child cases. We experienced 3 consecutive cases of bacterial meningitis in adults complicated by brain infarction. Primary causative organism were the Group B Streptococci in one case and the Streptococcus pneumoniae in other two cases. MRI, especially with FLAIR method and of coronal view, disclosed abnormal intensity areas near the brain surface. Conventional angiography and MR-angiography in the two cases showed tapering and stenosis of arteries. These cases suggest that routine use of MRI/ MRA in bacterial meningitis reveal neuro-vascular complications more frequently and easily. The benefits of adjunctive steroid therapy in the treatment of bacterial meningitis might be beneficial to suppression of these neurovascular complication cased by inflammatory vasculitis.
Subject(s)
Cerebral Infarction/etiology , Meningitis, Bacterial/complications , Meningitis, Pneumococcal/complications , Streptococcal Infections/complications , Aged , Anti-Inflammatory Agents/administration & dosage , Cerebral Infarction/diagnosis , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/drug therapy , Meningitis, Pneumococcal/drug therapy , Methylprednisolone/administration & dosage , Middle Aged , Streptococcal Infections/drug therapyABSTRACT
A 46-year-old woman presented with rippling muscle phenomenon. She complained of uncomfortable muscular stiffness of extremities and abdominal wall. Muscle contraction was easily elicited by percussion, which was visible from the surface and propagated in a rolling manner. The mounding (or myoedema) phenomenon was also remarkable. Three years later, malignant lymphoma (histologically, lymphoplasmacytoid lymphoma) was found in the sacrum. The lymphoma subsided with treatment by vincristine, cyclophosphamide, doxorubicin and prednisolone. Serum IgG as well as creatine kinase values were normalized. The rippling phenomenon also responded to the treatment. The present rippling muscle syndrome might be of a paraneoplastic or autoimmune origin related to lymphoma, although the evidence seemed indirect. We discussed the role of the internal membrane system of the skeletal muscle in the pathogenesis of rippling muscle.
