title: Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings.
abstract: Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. Cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. Latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. Patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.
authors.affiliation: Department of Neurology, The Aga Khan University, Karachi, Pakistan.
authors.forename: Asumul K
authors.initials: AK
authors.lastname: Bhojo
authors.forename: Naveed
authors.initials: N
authors.lastname: Akhter
authors.forename: Rohit
authors.initials: R
authors.lastname: Bakshi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Wasay
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004487:Edema / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications*; D010264:Paraplegia / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D013904:Thoracic Vertebrae
chemical_list: D000900:Anti-Bacterial Agents; D003907:Dexamethasone