Der Schmerz

, Volume 19, Issue 1, pp 55–58 | Cite as

Gekreuztes zentral-neuropathisches Schmerzsyndrom nach bakterieller Meningoenzephalitis

Fallbericht

Zusammenfassung

Wir berichten über eine 48-jährige Patientin, die nach einer zervikalen Myelographie an einer schweren Meningoenzephalitis mit Streptococcus acidominimus erkrankte. Aufgrund vaskulitischer Läsionen entwickelte sich im Verlauf ein gekreuztes neuropathisches Schmerzsyndrom mit mechanischer Allodynie und Hyperpathie des 2. Trigeminusastes rechts sowie von Rumpf und Extremitäten linksseitig. Diese Symptomatik lässt sich gut mit einer Läsion in der dorsolateralen Medulla oblongata rechts mit Schädigung des Tractus und Nucleus spinalis des Trigeminusnerven sowie des Tractus spinothalamicus lateralis erklären. Eine Kombinationstherapie von Gabapentin und Amitriptylin erwies sich als analgetisch gut wirksam, während niedrig-potente Opiate in Form von Tilidin in tolerabler Dosierung unwirksam waren.

Schlüsselwörter

Neuropathischer Schmerz Bakterielle Meningoenzephalitis Streptococcus acidominimus Medulla oblongata 

Crossed central neuropathic pain syndrome after bacterial meningoencephalitis

Abstract

We report on a 48 year old female patient who acquired a bacterial meningoencephalitis as a result of a cervical myelography. Examination of the cerebrospinal fluid (CSF) revealed 309 cells per microliter and Streptococcus acidominimus was isolated as the infectious agent. Cranial MRI demonstrated disseminated lesions predominantly in the pontine and medullary brain stem as well as in thalamic nuclei.

The patient developed a crossed central neuropathic pain syndrome. Neurological examination showed mechanic allodynia and hyperpathy along the left-sided extremities as well as right-sided neuropathic facial pain. On the MRI a dorsolateral medullary lesion on the right side, in the territory of the posterior inferior cerebellar artery was found. The localization of the lesion is suggestive of involvement of the spinal trigeminal tract or nucleus and the spinothalamic tract that would explain the neuropathic pain syndrome.

A combination of gabapentine and amitriptyline reduced the pain markedly whereas opioids failed to provide sufficient analgesia.

Keywords

Neuropathic pain Bacterial meningoencephalitis Streptococcus acidominimus Medullary brain stem 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Neurologische PoliklinikUniversität Ulm
  2. 2.Neurologische KlinikUniversität UlmUlm

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