Skip to main content
SpringerLink
Log in

Methylprednisolone pulse therapy as an adjuvant treatment of Streptococcus pneumoniae meningitis complicated by cerebral infarction—a case report and review of the literature

  • Brief Communication
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The role of methylprednisolone pulse therapy as adjuvant treatment of Streptococcus pneumoniae meningitis complicated by cerebral infarction has rarely been reported.

Methods

We reported a case report and also performed a systematic literature review.

Results

A 1-year 2-month-old boy who presented with high fever, status epilepticus, and septic shock was diagnosed with cerebral infarction caused by Streptococcus pneumoniae meningitis on magnetic resonance imaging (MRI). He was treated with methylprednisolone pulse therapy and his clinical condition gradually improved thereafter. At the follow-up visit 1 year after discharge, he was able to sit without support, but he had moderate delays in speech and developmental milestones and epilepsy sequelae.

Conclusion

In severe cases, the use of high-dose methylprednisolone should be considered to modulate the inflammatory response in patients with severe cerebral infarction caused by Streptococcus pneumoniae meningitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Auburtin M, Porcher R, Bruneel F, Scanvic A, Trouillet JL, Bédos JP, Régnier B, Wolff M (2002) Pneumococcal meningitis in the intensive care unit. Prognostic factors of clinical outcome in series of 80 cases. Am J Respir Crit Care Med 165:713–717

    Article  Google Scholar 

  2. Aviv RI, Benseler SM, DeVeber G, Silverman ED, Tyrrell PN, Tsang LM, Armstrong D (2007) Angiography of primary central nervous system angiitis of childhood: conventional angiography versus magnetic resonance angiography at presentation. AJNR Am J Neuroradiol 28:9–15

    Article  CAS  Google Scholar 

  3. van de Beek D, Farrar JJ, de Gans J, Mai NT, Molyneux EM, Peltola H, Peto TE, Roine I, Scarborough M, Schultsz C, Thwaites GE, Tuan PQ, Zwinderman AH (2010) Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol 9:254–263

    Article  Google Scholar 

  4. Brouwer MC, McIntyre P, Prasad K, van de Beek D (2013) Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 6:CD004405

    Google Scholar 

  5. de Gans J, van de Beek D (2002) The European dexamethasone in adulthood bacterial meningitis study investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:1549–1556

    Article  Google Scholar 

  6. Kastenbauer S, Pfister HW (2003) Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 126:1015–1025

    Article  Google Scholar 

  7. Iannetti L, Zito R, Bruschi S et al (2012) Recent understanding on diagnosis and management of central nervous system vasculitis in children. Clin Dev Immunol 2012:698327

    Article  Google Scholar 

  8. Ilia S, Spanaki AM, Raissaki M, Spoulou VI, Fitrolaki MD, Kanariou M, Tzanakaki G, Briassoulis G (2011) Complicated pneumococcal meningitis in a fully vaccinated child: value of magnetic resonance imaging monitoring. Neuropediatrics 42:240–244

    Article  CAS  Google Scholar 

  9. Jorens PG, Parizel PM, Demey HE, Smets K, Jadoul K, Verbeek MM, Wevers RA, Cras P (2005) Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology 47:758–764

    Article  Google Scholar 

  10. Jorens PG, Parizel PM, Wojciechowski M, Laridon A, de Weerdt A, Mertens G, Ceulemans B (2008) Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions. Eur J Paediatr Neurol 12:127–132

    Article  Google Scholar 

  11. Laky D, Filon V, Rãdulescu M, Socolovschi S, Hălălău F (1992) Up-to-date aspects of meningoencephalitis. Anatomo-clinical researches. Romanian J Morphol Embryol 38:107–114

    CAS  Google Scholar 

  12. McDaneld LM, Fields JD, Bourdette DN, Bhardwaj A (2010) Immunomodulatory therapies in neurologic critical care. Neurocrit Care 12:132–143

    Article  Google Scholar 

  13. Mook-Kanamori BB, Geldhoff M, van der Poll T, van de Beek D (2011) Pathogenesis and pathophysiology of pneumococcal meningitis. Clin Microbiol Rev 24:557–591

    Article  CAS  Google Scholar 

  14. Safadieh L, Sharara-Chami R, Dabbagh O (2012) Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis. Case Rep Med 2012:965932

    Article  Google Scholar 

  15. Schutte C, van der Meyden C (1998) A prospective study of Glasgow Coma Scale (GCS), age, CSF-neutrophil count, and CSF-protein and glucose levels as prognostic indicators in 100 adult patients with meningitis. J Inf Secur 37:112–115

    CAS  Google Scholar 

  16. Teixeira J, Zimmerman RA, Haselgrove JC, Bilaniuk LT, Hunter JV (2001) Diffusion imaging in pediatric central nervous infections. Neuroradiology 43:1031–1039

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This research was performed by the Pediatric Sepsis Study Group at Chang Gung Children’s Hospital in Taoyuan, Taiwan.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was supported in part by grants from Chang Gung Memorial Hospital (grants: CMRPG3B0841, CMRPG3B0842, and CMRPG3B0843, IRB: 201600446B0).

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine and Pediatric Neurocritical Care Center, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Oi-Wa Chan, Jainn-Jim Lin, Shao-Hsuan Hsia & Chia-Ying Lin

  2. Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Jainn-Jim Lin & Kung-Lin Lin

  3. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Jainn-Jim Lin

Authors
  1. Oi-Wa Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jainn-Jim Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shao-Hsuan Hsia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chia-Ying Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kung-Lin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

OWC and JJL conceived the study; CYL, JJL, OWC, SHH, and KLL participated in data collection; and OWC, CYL, and JJL participated in the design and coordination. OWC drafted the manuscript and JJL critically revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Jainn-Jim Lin.

Ethics declarations

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, OW., Lin, JJ., Hsia, SH. et al. Methylprednisolone pulse therapy as an adjuvant treatment of Streptococcus pneumoniae meningitis complicated by cerebral infarction—a case report and review of the literature. Childs Nerv Syst 36, 229–233 (2020). https://doi.org/10.1007/s00381-019-04485-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-019-04485-6

Keywords

Search

Navigation