Bhojo Asumul K, Akhter Naveed, Bakshi Rohit, Wasay Mohammad
Department of Neurology, The Aga Khan University, Karachi, Pakistan.
Am J Med Sci. 2002 May;323(5):263-5. doi: 10.1097/00000441-200205000-00006.
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.
脊髓功能障碍是脑膜炎奈瑟菌（脑膜炎球菌）性脑膜炎的一种罕见并发症。我们报告一名17岁患者，有3天发热、头痛、呕吐、烦躁及无反应病史。脑脊液显示明显的多形核白细胞增多。乳胶颗粒凝集试验脑膜炎球菌呈阳性。给予患者静脉用抗生素及静脉用地塞米松。在接下来的4天里，他出现下肢无力，伴有反射消失及伸性跖反射。MRI显示T2加权像上T4至T9胸段脊髓及4个脑脓肿连续高信号。5个月后，他脑功能恢复，但截瘫仍存在。该病例说明脊髓病可能是急性脑膜炎球菌性脑膜炎的并发症，可能由于血管炎、中风、自身免疫性脊髓病或脊髓直接感染所致。伴有急性脑膜炎的脊髓病患者应接受脊髓MRI检查。此外，急性脊髓病患者应考虑脑膜炎。
