Cushing's triad in pneumococcal meningitis due to brainstem ischemia: early detection by diffusion-weighted MRI.
An infant with pneumococcal meningitis developed signs of raised intracranial pressure during the progression of the disease, including loss of consciousness, hypertension, bradycardia, and respiratory depression. However, both the emergency computed tomography scan findings and intracranial pressure measured by lumbar puncture were normal. Diffusion-weighted magnetic resonance imaging identified multiple lesions with restricted diffusion suggestive of ischemia in the brainstem, explaining the signs observed in the patient. These lesions could not be identified on T(2)-weighted images at that time.
Haarman
Eric G
EG
Department of Pediatrics, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands. EG.Haarman@vumc.nl
Vermeulen
R Jeroen
RJ
van Furth
A Marceline
AM
Verbeke
Jonathan I M L
JI
Plötz
Frans B
FB
D001919:Bradycardia / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D001933:Brain Stem; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology*