ABSTRACT
Three patients with a central and peripheral nervous system disease complicating a Mycoplasma pneumoniae (M. pn.) infection are presented. Patient 1 suffered from bilateral optic neuritis as well as acute Guillain-Barré syndrome recovering after plasmapheresis. The two other patients suffered from severe haemorrhagic leukoencephalitis (Hurst) which only could be contained by aggressive decompressive craniectomy with duraplasty. All three illnesses were clearly shown to be associated with M. pn. infection. Our three patients represent the full scale of central nervous (CNS) (cerebral and myelitic) as well as peripheral nervous system (PNS) (GBS, optic neuritis) manifestation of a disease caused by the same pathogenetic - post-infectious - mechanism; pathogenic CNS and PNS epitopes might be shared in post-infectious neurological disease following M. pn. infection.
Subject(s)
Guillain-Barre Syndrome/etiology , Leukoencephalitis, Acute Hemorrhagic/etiology , Mycoplasma pneumoniae , Optic Neuritis/etiology , Pneumonia, Mycoplasma/complications , Adolescent , Adult , Brain/pathology , Guillain-Barre Syndrome/pathology , Guillain-Barre Syndrome/therapy , Humans , Leukoencephalitis, Acute Hemorrhagic/pathology , Leukoencephalitis, Acute Hemorrhagic/therapy , Magnetic Resonance Imaging , Male , Middle Aged , Optic Neuritis/pathology , Optic Neuritis/therapy , Pneumonia, Mycoplasma/pathology , Pneumonia, Mycoplasma/therapy , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To report the feasibility of craniectomy with duraplasty in four patients with life-threatening encephalitis and, in particular, their long-term outcome. DESIGN: Report of four cases, analysis of the acute clinical course and neurological long-term sequelae. RESULTS: Generous craniectomy with duraplasty was performed in four patients with life-threatening encephalitis leading to decortication and decerebration. This treatment approach reduced intracranial pressure. The long-term sequelae (1.5-8 years after craniectomy) confirmed its appropriateness, having led to full neurological (cerebral) function, resocialization, and reintegration into their professional life in all four patients. CONCLUSION: Craniectomy with dural augmentation is a treatment approach in cases of severe space-occupying encephalitis, not only saving the patient's life but also leading to favorable long-term outcome.
