Elsevier

Pediatric Neurology

Volume 20, Issue 2, February 1999, Pages 152-154
Pediatric Neurology

Case Reports
Cauda equina syndrome complicating pneumococcal meningitis

https://doi.org/10.1016/S0887-8994(98)00129-5Get rights and content

Abstract

A 14-month-old female with pneumococcal meningitis presented with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging of the spine demonstrated intense gadolinium enhancement of the cauda equina, whereas the conus medullaris appeared normal. This finding indicated that lumbosacral polyradiculopathy caused her symptoms.

Introduction

The neurologic complications of bacterial meningitis, including hearing deficits, seizures, hydrocephalus, cranial nerve palsies, hemiparesis, and quadriparesis have been well documented in the literature [1]. However, spinal involvement is rare in nontuberculous bacterial meningitis. Previous reports have described transverse myelopathy, Brown-Séquard’s syndrome, and conus medullaris syndrome resulting from spinal cord vasculitis or infarction [2], [3], [4], [5], [6], [7], [8], [9], [10]. The authors report a case of lumbosacral polyradiculopathy, with resultant flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunctions after Streptococcus pneumoniae meningitis.

Section snippets

Case report

A 14-month-old female with a fever for 12 hours developed seizures and was admitted to the authors’ hospital on day 2. On admission, she was lethargic, but respiration was normal. Blood pressure was 116/62 mm Hg. Pinprick stimulation of the upper extremities produced withdrawal and asymmetric grimacing, which indicated right facial palsy. Lower extremities were hypotonic and did not move against any stimuli. Deep tendon reflexes were normal in the upper extremities but absent in both knees and

Discussion

Spinal dysfunction is an uncommon complication of bacterial meningitis. Recently, Moffett and Berkowitz [2] reviewed 23 patients with spinal cord dysfunction after bacterial meningitis. Of the 18 survivors, only two demonstrated complete neurologic recovery, and the remaining 16 patients exhibited spastic quadriplegia, paraplegia, with increased deep tendon reflexes, walking difficulties, and abnormalities of bowel and bladder function. The pathogenesis involves several mechanisms. Spinal cord

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