[Crossed central neuropathic pain syndrome after bacterial meningoencephalitis].
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.
Henkel
K
K
Neurologische Poliklinik, Universität Ulm.
Bengel
D
D
D004660:Encephalitis / Q000382:microbiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000503:physiopathology*; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000503:physiopathology