Early cortical cytotoxic edema in meningococcal meningitis.
Meningococcal disease frequently presents neurologic sequels via vascular, metabolic, or inflammatory processes. Understanding the underlying pathogenic mechanisms may influence both treatment and outcome. We present a 2-year-old child affected by Neisseria meningitidis sepsis, who on the second day from clinical onset manifested recurrent partial motor seizures and focal neurologic signs. An early magnetic resonance angiography of the circle of Willis produced normal results, whereas magnetic resonance imaging of the brain disclosed cortical signal abnormalities consistent with cytotoxic edema, without involvement of the adjacent white matter. Six-month follow-up magnetic resonance imaging of the brain indicated faint cortical atrophy in the same regions, although the neurologic picture had resolved. The literature contains few data on early magnetic resonance parenchymal changes, and their pathogenic mechanism is controversial. Diffusion-weighted images may contribute to an understanding of the mechanisms of such brain damage.
Citton
Valentina
V
Neuroradiologic Unit, University Hospital, Padua, Italy. valentina.citton@sanita.padova.it
Toldo
Irene
I
Calderone
Milena
M
Sartori
Stefano
S
Manara
Renzo
R
D001921:Brain / Q000098:blood supply / Q000473:pathology; D001929:Brain Edema / Q000473:pathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology*; D002675:Child, Preschool; D002941:Circle of Willis / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008585:Meningitis, Meningococcal / Q000188:drug therapy / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome