Neuroradiology

, Volume 47, Issue 10, pp 758–764

Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge

Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids
  • Philippe G. Jorens
  • Paul M. Parizel
  • Hendrik E. Demey
  • Katrien Smets
  • Kris Jadoul
  • M. M. Verbeek
  • R. A. Wevers
  • Patrick Cras
Diagnostic Neuroradiology

Abstract

Streptococcus pneumoniae is a common cause of bacterial meningitis but only rarely causes other infections such as brain abscess, encephalitis, encephalomyelitis or meningoencephalitis. We report on three adult patients with meningoencephalitis caused by S. pneumoniae. In all three, CT and MRI revealed widespread brain lesions, suggesting extensive parenchymal injury. Diffusion-weighted MRI showed lesions with restricted diffusion, reflecting local areas of ischaemia with cytotoxic oedema secondary to an immunologically mediated necrotising vasculitis and thrombosis. High levels of markers of neuronal, glial and myelin damage were found in the cerebrospinal fluid. According to the literature, brain parenchyma lesions in adults with pneumococcal meningoencephalitis are often associated with death or severe neurological deficit. Our patients were treated with pulse doses of glucocorticoids: this resulted in dramatic clinical improvement and an excellent final neurological recovery.

Keywords

Meningoencephalitis Meningitis Encephalitis Streptococcus pneumoniae Glucocorticoids MRI 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Philippe G. Jorens
    • 1
  • Paul M. Parizel
    • 2
  • Hendrik E. Demey
    • 1
  • Katrien Smets
    • 3
    • 4
  • Kris Jadoul
    • 4
  • M. M. Verbeek
    • 5
  • R. A. Wevers
    • 5
  • Patrick Cras
    • 3
  1. 1.Department of Intensive Care MedicineUniversity Hospital of Antwerp, UZAEdegemBelgium
  2. 2.Department of RadiologyUniversity of AntwerpEdegemBelgium
  3. 3.Department of NeurologyUniversity of AntwerpEdegemBelgium
  4. 4.Department of NeurologyGeneral Hospital AZ MiddelaresSint-NiklaasBelgium
  5. 5.Laboratory of Paediatrics and NeurologyUniversity Hospital of NijmegenNijmegenThe Netherlands

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