 |
|
Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults
MRI Findings Suggest Extensive Myelitis
Stefan Kastenbauer, MD;
Frank Winkler, MD;
Gunther Fesl, MD;
Xaver Schiel, MD;
Helmut Ostermann, MD, PhD;
Tarek A. Yousry, MD, PhD;
Hans Walter Pfister, MD, PhD
Arch Neurol. 2001;58:806-810.
Background Bacterial meningitis is rarely complicated by acute spinal cord involvement
(eg, myelitis, ischemic infarction, spinal abscess, or epidural hemorrhage).
In spinal cord dysfunction, magnetic resonance imaging (MRI) is the imaging
modality of choice. Still, MRI findings of myelitis due to bacterial meningitis
in adults have not been reported.
Methods Spinal MRIs were obtained during the acute stage of meningitis and on
follow-up in 3 adults with bacterial meningitis that was complicated by paraparesis
or tetraparesis and bowel and bladder incontinence. The causative pathogens
were Streptococcus pneumoniae and Neisseria meningitidis; in 1 patient, the pathogen was not identified.
Results In all cases, spinal MRI ruled out a compression of the cord by an extramedullary
mass but demonstrated hyperintensities on T2-weighted images that predominantly
involved the gray matter and extended from the cervical to the lumbar cord.
Leptomeningeal and discrete nodular intramedullary enhancement on T1-weighted
images was detected only in 1 patient. Follow-up examinations revealed that
hyperintensities resolved completely in 1 patient, while a central cavitation
developed in the cervical spinal cord of another, and the MRI findings were
progressive during the first 4 weeks in the third patient. In all cases, severe
paresis and bowel and bladder incontinence persisted.
Conclusion We demonstrate for the first time the MRI findings of adults with acute
spinal cord involvement during bacterial meningitis. Magnetic resonance imaging
showed central intramedullary hyperintensities on T2-weighted images that
extended from the cervical to the lumbar cord, indicating myelitis. Clinical
follow-up examinations suggest that myelitis during bacterial meningitis has
an unfavorable prognosis.
From the Departments of Neurology (Drs Kastenbauer, Winkler, and Pfister),
Neuroradiology (Drs Fesl and Yousry), and Internal Medicine (Drs Schiel and
Ostermann), Klinikum Großhadern, Ludwig-Maximilians University, Munich,
Germany.
Corresponding author and reprints: Hans Walter Pfister, MD, Department
of Neurology, Ludwig-Maximilians University, Marchioninistrasse 15, 81377
Munich, Germany (e-mail: Pfister{at}nefo.med.uni-muenchen.de).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLES
Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults: MRI Findings Suggest Extensive Myelitis
Karen L. Roos
Arch Neurol. 2001;58(5):717-718.
EXTRACT
| FULL TEXT
Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2001;58(5):840-841.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Neurolisteriosis presenting as cervical myelitis in an immunocompetent patient
Josephson et al.
Neurology 2006;66:1122-1123.
FULL TEXT
Pneumococcal meningitis in adults: Spectrum of complications and prognostic factors in a series of 87 cases
Kastenbauer and Pfister
Brain 2003;126:1015-1025.
ABSTRACT
| FULL TEXT
Acute Severe Spinal Cord Dysfunction in Bacterial Meningitis in Adults: MRI Findings Suggest Extensive Myelitis
Roos
Arch Neurol 2001;58:717-718.
FULL TEXT
|
