Case reportsSpinal cord infarction in meningitis: Polygenic risk factors
Introduction
In children, long-term neurologic consequences of bacterial meningitis include developmental impairment, hearing loss, blindness, hydrocephalus, hypothalamic dysfunction, hemiparesis, and tetraparesis [1], [2]. Spinal cord infarction after meningitis is rare with unclear pathophysiology. In meningitis, infarction is associated with inflammation that affects vascular caliber and tone while increasing intracranial pressure [3].
We report a case of spinal cord infarction after Streptococcus pneumoniae meningitis in a male with previously unrecognized hypercoagulability disorder and concomitant structural brain anomaly. The patient’s unique presentation illustrates the importance of recognizing the risk factors and clinical manifestations of spinal cord infarction. It also demonstrates the need to consider Chiari I malformation as a risk factor for acute cervical infarction in the presence of meningitis.
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Case report
A 6-year-old male was transferred to our pediatric intensive care unit from a community hospital for bacterial meningitis with altered mental status. The child had been brought to the emergency department by his parents with worsening frontal headache, six episodes of nonbloody, nonbilious vomiting, and fever to 38.7°C. Since the onset of the illness, the male became progressively weaker and listless.
Upon further questioning, a 2-week history of mild cough and increasing nasal congestion was
Methods
Using PubMed/MEDLINE, we conducted a survey of English-language medical literature using the keywords “spinal cord infarction” in combination with “Chiari malformation” and “factor V Leiden deficiency.” Additionally, we examined bibliographies of selected articles and reviewed specialty textbooks.
Results
Several reports of spinal cord infarction after infection with Haemophilus influenzae and Neisseria meningitidis were identified. In 1997, Moffett and Berkowitz reviewed 23 cases of spinal cord dysfunction associated with acute bacterial meningitis over a 25-year period [4]. Of these, 21 occurred in patients less than 21 years of age. Streptococcus pneumoniae was the isolated organism in four cases; three were characterized by tetraplegia [2], [5], [6], [7]. None of the affected children were
Discussion
In a recent study of adults, tetraparesis resulting from spinal cord ischemia occurred in 2% of patients with meningitis but is likely uncommon in children [10]. To our knowledge, this is the first report of spinal cord infarction in a patient with acute bacterial meningitis who had both an underlying structural brain anomaly and a hypercoagulability disorder. We propose that the presence of multiple concomitant risk factors predisposed this male to spinal cord infarction and paralysis.
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Cited by (0)
Almasanu BP, Owensby JR, Pavlakis SG, Edwards JH. Spinal cord infarction in meningitis: Polygenic risk factors.