Extensive cortical infarctions post-acute meningoencephalitis: A case report with literature review

E. Ogbimi, N. Kogha, N. Emma-Nzekwue, SO Emagboron
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Abstract

Background: Central nervous infections can present with or be complicated by acute infarctions similar to those seen in acute ischaemic stroke. Multiple and extensive cortical infarctions is an uncommon complication of acute bacterial meningitis in the young adult population and is associated with a poor prognosis. Findings: We present a case of a 41year old male bar attendant with extensive cortical infarctions post-acute meningoencephalitis. He was referred to our facility with a history of sore throat, fever, headache, neck pain and irrational behaviour. Initial Brain Computerised Tomography scan (CT) at presentation was normal, however a throat swab had revealed non-haemolytic streptococci and Cerebrospinal fluid analysis showed growth of streptococcal species (spp.). He was commenced on empirical intravenous antibiotics. A repeat brain CT scan ordered for after a week on admission due to patient’s deteriorating state showed extensive multiple cortical and subcortical infarctions bilaterally involving the pons, cerebellar, and cerebral cortex. Despite intensive management, we lost the patient after eighteen (18) days on admission. Conclusion: The presence of multiple infarctions portends a worse prognosis and should prompt more vigilance in the management of such patients.
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急性脑膜脑炎后大面积皮质梗塞:病例报告与文献综述
背景:中枢神经感染可出现或并发急性脑梗死,类似于急性缺血性中风。多发性大面积皮质梗死是急性细菌性脑膜炎在年轻人群中不常见的并发症,且预后不良:我们报告了一例 41 岁男性酒吧服务员急性脑膜炎后大面积皮质梗死的病例。他因咽喉痛、发烧、头痛、颈部疼痛和行为反常被转诊至我院。最初的脑计算机断层扫描(CT)结果正常,但咽拭子显示有非溶血性链球菌,脑脊液分析显示有链球菌生长。他开始接受经验性静脉抗生素治疗。入院一周后,由于患者病情恶化,我们再次对他进行了脑部 CT 扫描,结果显示双侧大脑皮质和皮质下广泛多发梗死,涉及脑桥、小脑和大脑皮质。尽管对患者进行了精心治疗,但入院十八(18)天后患者还是去世了:结论:多发性脑梗塞预示着较差的预后,在治疗此类患者时应提高警惕。
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