RESUMEN
We report the case of a 33-year-old man with a brainstem infarction due to concomitant occlusions in the left internal carotid, both vertebral, and basilar arteries. The patient had experienced a severe Mycoplasma pneumoniae infection about 10 months prior to symptom onset, and his Mycoplasma antibody titre was positive when the stroke occurred. Despite performing meticulous neurological, vascular, and medical evaluations, we were unable to detect other possible causes of the stroke. Therefore, the multiple occlusions in the major cerebral arteries of our patient were concluded to be related to M. pneumoniae infection.
Asunto(s)
Infartos del Tronco Encefálico/etiología , Infartos del Tronco Encefálico/microbiología , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/microbiología , Infecciones por Mycoplasma/complicaciones , Adulto , Antibacterianos/uso terapéutico , Enfermedades de los Pequeños Vasos Cerebrales , Imagen de Difusión por Resonancia Magnética , Humanos , Masculino , Infecciones por Mycoplasma/tratamiento farmacológico , Mycoplasma pneumoniae/patogenicidadRESUMEN
BACKGROUND AND PURPOSE: Vasculitis and infarcts are well-established sequelae of bacterial meningitis. However, early large-vessel involvement is rare, particularly within the brainstem. There has been one previous case report of a young male who presented with pontine infarct as an early manifestation of Streptococcus milleri meningitis. We present another case of brainstem infarction associated with meningitis caused by Streptococcus anginosus. CASE DESCRIPTION: We report a 58-year-old man who developed constitutional symptoms and gait instability, followed by progressive stupor. On examination, he had a Glasgow Coma Scale of 8 with intact brainstem reflexes and no focal findings. Magnetic resonance imaging documented bilateral pontine infarcts. S. anginosus was isolated from cerebrospinal fluid. Despite proper antibiotic treatment, the patient remained comatose and care was withdrawn. Postmortem examination revealed the meningitis was predominantly localized at the base of the brain. In addition, ventriculitis, multiple abscesses, and multiple infarcts in the pons and midbrain were found. CONCLUSION: S. anginosus, which is part of the normal human flora, causes invasive pyogenic infections and is an uncommon cause of bacterial meningitis. This type of infection is mostly situated at the base of the brain and has a propensity to encase the basilar artery and its perforators, thus causing brainstem stroke early in its course.