Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Oct 9:2018:9439021.
doi: 10.1155/2018/9439021. eCollection 2018.

Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism

Philippe Hantson  1 , Thierry Duprez  2
Affiliations
Case Reports

Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism

Philippe Hantson et al. Case Rep Neurol Med. .

Abstract

A 75-year-old woman was admitted to ICU with coma following Streptococcus pneumoniae meningitis with bacteremia. Her Glasgow Coma Scale (GCS) score fluctuated around 4 to 6 over the next four weeks. There was no evidence of increased intracranial pressure (ICP). Electroencephalogram (EEG) showed only diffuse aspecific slowing. Impaired cerebral blood flow (CBF) autoregulation was suggested at transcranial Doppler (TCD). Repeated brain magnetic resonance imaging (MRI) examination failed to demonstrate venous thrombosis, arterial ischemic stroke, or brain abscesses but revealed diffuse but reversible cortical cytotoxic edema at diffusion-weighted (DW) sequences. The brain FDG-positron emission tomography (FDG-PET) showed diffuse cortical hypometabolism. The patient unexpectedly experienced a complete neuropsychological recovery the next few weeks. The suggested hypothesis to explain this unusual disease course could be a transient alteration of CBF autoregulation due to some degree of diffuse subcortical microangiopathy. A concomitant reduction of brain metabolism probably prevented the progression towards cortical irreversible ischemic damage.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Brain 18fluorodeoxyglucose (FDG) positron emission tomography (PET) showing diffuse cortical hypometabolism featured by decreased uptake of the tracer.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Katchanov J., Heuschmann P. U., Endres M., Weber J. R. Cerebral infarction in bacterial meningitis: Predictive factors and outcome. Journal of Neurology. 2010;257(5):716–720. doi: 10.1007/s00415-009-5395-9. - DOI - PubMed
    1. Weisfelt M., Van De Beek D., Spanjaard L., Reitsma J. B., De Gans J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: A prospective case series. The Lancet Neurology. 2006;5(2):123–129. doi: 10.1016/S1474-4422(05)70288-X. - DOI - PubMed
    1. Kastenbauer S., Pfister H.-W. Pneumococcal meningitis in adults: Spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003;126(5):1015–1025. doi: 10.1093/brain/awg113. - DOI - PubMed
    1. Weststrate W., Hijdra A., De Gans J. Brain infarcts in adults with bacterial meningitis [10] The Lancet. 1996;347(8998):p. 399. - PubMed
    1. Schut E. S., Brouwer M. C., De Gans J., Florquin S., Troost D., Van De Beek D. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009;73(23):1988–1995. doi: 10.1212/WNL.0b013e3181c55d2e. - DOI - PubMed

Publication types

LinkOut - more resources