A Challenging Case of Streptococcus pneumoniae Meningitis in a 64-Year-Old Woman Who Presented with Symptoms of Cerebellar Hemorrhage

Abstract

BACKGROUND There is a recognized association between bacterial meningitis and intracranial hemorrhage. However, acute neurological symptoms at presentation, with confirmation of hemorrhage on imaging, may delay further investigations, including blood culture for diagnosing an infection. This report presents a challenging case of Streptococcus pneumoniae meningitis in a 64-year-old woman who presented with symptoms of cerebellar hemorrhage. CASE REPORT This report describes a 64-year-old woman who had a medical history of untreated diabetes mellitus. She was brought to our hospital with headache and impaired consciousness, complicated with fever. Based on the hemorrhage in the left cerebellar hemisphere detected in the head CT findings, the patient was initially diagnosed with cerebellar hemorrhage. However, a positive blood culture after 12 hours of admission made the physician consider a central nervous system infection as the cause of the hemorrhage and perform a lumbar puncture. Therefore, the patient was diagnosed with acute bacterial meningitis caused by Streptococcus pneumoniae, and antibiotic treatment was started immediately. Although her general condition improved after antibiotic treatment, her mental status did not improve completely. CONCLUSIONS This report highlights that the clinicians should be aware that bacterial meningitis may result in intracranial hemorrhage. Patients with symptoms of a hemorrhagic stroke should be thoroughly investigated to avoid a delay in the treatment of infection.

Figure 1.

The head CT findings. (A) Head CT scan shows an intracerebral hemorrhage in the left cerebellar hemisphere (long arrow). (B) Head CT scan reveals a fluid collection in the right maxillary paranasal sinus (short arrow). CT – computed tomography

Figure 2.

Clinical course of the patient. The head CT scan shows an intracerebral hemorrhage in the left cerebellar hemisphere (long arrow) on admission. Systemic corticosteroid and antibiotic therapies were administered 12 hours after admission. MRI fluid-attenuated inversion recovery (FLAIR) sequence performed on Day 4 shows bright sulci with features suggestive of subarachnoid hemorrhage (arrowhead). CT – computed tomography; MRI – magnetic resonance imaging