Meningococcal meningitis presenting as stroke in an afebrile adult.
We describe a healthy, afebrile 26-year-old man who presented to the emergency department with left hemiparesis and cranial nerve deficits caused by meningococcal meningitis. The results of the computed tomographic scan of the head were negative. Magnetic resonance imaging showed lesions in the basal ganglia and caudate consistent with ischemic infarcts. The neurologic deficits initially progressed but improved to near-resolution after 1 month. This case was unusual in that the patient was afebrile despite a high bacterial load and significant neurologic deficits. His presentation thus mimicked a straightforward stroke. Close attention to the physical examination findings led to a comprehensive evaluation that yielded the correct diagnosis.
Hsu
S S
SS
Division of Emergency Medicine, Department of Surgery, University of Maryland Medical System, Baltimore, MD, USA.
Kim
H S
HS
D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001831:Body Temperature; D002561:Cerebrovascular Disorders / Q000175:diagnosis; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008585:Meningitis, Meningococcal / Q000175:diagnosis* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone