Noncompressive myelopathy in acute community-acquired bacterial meningitis: Report of seven cases and review of literature

Abstract

Background and purpose: Bacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported.

Methods: Cases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis.

Results: Noncompressive myelopathy was reported in seven of 3047 episodes of community-acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17-77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2-28). Spinal magnetic resonance imaging showed T2-weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44).

Conclusions: Noncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits.

Keywords: bacterial meningitis; myelitis; spinal cord diseases.

FIGURE 1

Spinal magnetic resonance imaging (MRI) images of patients with noncompressive myelopathy secondary to bacterial meningitis. (a) T2‐weighted sagittal spinal MRI shows an hyperintense lesion at T6–T7. This patient was diagnosed with postinflammatory myelitis. (b) T2‐weighted sagittal spinal MRI shows a longitudinal hyperintense lesion in a large part of the thoracic spinal cord. This patient was also diagnosed with postinflammatory myelitis. (c, d) T2‐weighted sagittal spinal MRI shows a longitudinal hyperintense lesion in the lower cervical spinal cord (c) and an epidural abscess at C1–C2 (d) on T1‐weighted images. This patient was diagnosed with infectious myelitis.