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Case Reports
. 2020 Feb 12;6(1):20190068.
doi: 10.1259/bjrcr.20190068. eCollection 2020 Mar.

Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

Surrin S Deen, Jennifer Boyes  1 , Bankole Oyewole  1 , Anna Bahk  1 , George Thomas  1 , Gunaratnam Gunathilagan
Affiliations
Case Reports

Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

Surrin S Deen et al. BJR Case Rep. .

Abstract

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn's disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.

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Figures

Figure 1.
Figure 1.
(a) DWI showing a small left occipital lesion (arrow); (b) ADC map does not depict a clear lesion corresponding to that seen on DWI. ADC, apparent diffusion coefficient; DWI, diffusion-weightedimaging.
Figure 2.
Figure 2.
Repeat MRI images under sedation (a) DWI image showing a small left occipital lesion (arrow); (b) ADC map showing a small area of low ADC (arrow) corresponding to the lesion on DWI; (c) T2 weighted image showing no significant changes in the region of the lesion; (d) post-contrast image showing no contrast uptake or ring-enhancement at the site of the lesion. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging.
Figure 3.
Figure 3.
The patient’s CT angiogram of (a) the carotids showing no significant stenosis and (b) the intracranial blood vessels.
See this image and copyright information in PMC

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