title: Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids.
abstract: Streptococcus pneumoniae is a common cause of bacterial meningitis but only rarely causes other infections such as brain abscess, encephalitis, encephalomyelitis or meningoencephalitis. We report on three adult patients with meningoencephalitis caused by S. pneumoniae. In all three, CT and MRI revealed widespread brain lesions, suggesting extensive parenchymal injury. Diffusion-weighted MRI showed lesions with restricted diffusion, reflecting local areas of ischaemia with cytotoxic oedema secondary to an immunologically mediated necrotising vasculitis and thrombosis. High levels of markers of neuronal, glial and myelin damage were found in the cerebrospinal fluid. According to the literature, brain parenchyma lesions in adults with pneumococcal meningoencephalitis are often associated with death or severe neurological deficit. Our patients were treated with pulse doses of glucocorticoids: this resulted in dramatic clinical improvement and an excellent final neurological recovery.
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Antwerp, UZA, Wilrijkstraat 10, 2650 Edegem, Belgium. Philippe.Jorens@uza.be
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.forename: Paul M
authors.initials: PM
authors.lastname: Parizel
authors.forename: Hendrik E
authors.initials: HE
authors.lastname: Demey
authors.forename: Katrien
authors.initials: K
authors.lastname: Smets
authors.forename: Kris
authors.initials: K
authors.lastname: Jadoul
authors.forename: M M
authors.initials: MM
authors.lastname: Verbeek
authors.forename: R A
authors.initials: RA
authors.lastname: Wevers
authors.forename: Patrick
authors.initials: P
authors.lastname: Cras
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D005938:Glucocorticoids; D008775:Methylprednisolone