Lee Sung B, Jones Lyell K, Giannini Caterina
Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Neurocrit Care. 2005;3(2):157-60. doi: 10.1385/NCC:3:2:157.
Vasculitis and infarcts are well-established sequelae of bacterial meningitis. However, early large-vessel involvement is rare, particularly within the brainstem. There has been one previous case report of a young male who presented with pontine infarct as an early manifestation of Streptococcus milleri meningitis. We present another case of brainstem infarction associated with meningitis caused by Streptococcus anginosus.
We report a 58-year-old man who developed constitutional symptoms and gait instability, followed by progressive stupor. On examination, he had a Glasgow Coma Scale of 8 with intact brainstem reflexes and no focal findings. Magnetic resonance imaging documented bilateral pontine infarcts. S. anginosus was isolated from cerebrospinal fluid. Despite proper antibiotic treatment, the patient remained comatose and care was withdrawn. Postmortem examination revealed the meningitis was predominantly localized at the base of the brain. In addition, ventriculitis, multiple abscesses, and multiple infarcts in the pons and midbrain were found.
S. anginosus, which is part of the normal human flora, causes invasive pyogenic infections and is an uncommon cause of bacterial meningitis. This type of infection is mostly situated at the base of the brain and has a propensity to encase the basilar artery and its perforators, thus causing brainstem stroke early in its course.
血管炎和梗死是细菌性脑膜炎公认的后遗症。然而，早期大血管受累情况罕见，尤其是在脑干。此前曾有一例年轻男性病例报告，其以脑桥梗死作为米勒链球菌脑膜炎的早期表现。我们现报告另一例与咽峡炎链球菌脑膜炎相关的脑干梗死病例。
我们报告一名58岁男性，最初出现全身症状和步态不稳，随后逐渐陷入昏迷。检查时，其格拉斯哥昏迷量表评分为8分，脑干反射完整，无局灶性体征。磁共振成像显示双侧脑桥梗死。脑脊液培养分离出咽峡炎链球菌。尽管给予了恰当的抗生素治疗，患者仍昏迷不醒，最终放弃治疗。尸检发现脑膜炎主要局限于脑底部。此外，还发现了脑室炎、多处脓肿以及脑桥和中脑的多处梗死。
咽峡炎链球菌是人类正常菌群的一部分，可引起侵袭性化脓性感染，是细菌性脑膜炎的罕见病因。这类感染大多位于脑底部，易于包裹基底动脉及其穿支，从而在病程早期导致脑干卒中。
