Spinal cord infarction: a rare but serious complication of pneumococcal meningoencephalitis

BMJ Case Rep. 2024 Jan 3;17(1):e252209. doi: 10.1136/bcr-2022-252209.

Abstract

Here, we report the case of a woman in her 40s who came with pyogenic meningitis and infarcts in the brain. While on treatment with antibiotics, she developed new-onset weakness involving bilateral lower limbs and one upper limb 2 weeks into the course of illness. MRI of the spine showed an infarct in the spinal cord. Spinal cord infarction as a complication of pyogenic meningitis is not well recognised unlike tuberculosis meningitis. Unlike ischaemic strokes where thrombolysis is done, for stroke related to infections, there are no definite strategies. Our patient was treated with physiotherapy, continued on antibiotics and slowly recovered over months and at 18-month follow-up, she was walking with a walker. The exact mechanism of thrombosis is not known but may be due to inflammation of the arterial wall and activation of the procoagulant cascade by infection-triggered inflammation. Spinal cord infarction can occur at any phase of the infection and may occur despite appropriate response to antibiotic treatments.

Keywords: Infection (neurology); Meningitis; Spinal cord; Stroke.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Female
  • Humans
  • Infarction / etiology
  • Inflammation / complications
  • Ischemic Attack, Transient* / complications
  • Magnetic Resonance Imaging
  • Meningitis, Bacterial* / complications
  • Meningoencephalitis* / complications
  • Spinal Cord / diagnostic imaging
  • Spinal Cord Ischemia* / diagnostic imaging
  • Spinal Cord Ischemia* / etiology
  • Streptococcus pneumoniae

Substances

  • Anti-Bacterial Agents