Takada Koji, Kojima Susumu, Hayashi Takuya, Fujii Tatsuya, Shirotani Toshiki, Kohyama Shinya, Maeda Takahiro
Department of Neurology, Misyuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
No To Shinkei. 2006 Apr;58(4):329-34.
Fatality rates and the number of patients suffering from the after sequelae of bacterial meningitis have still remained high despite the development of new antibiotics. Cerebrovascular complications have been reported less frequently in adult cases than in child cases. We experienced 3 consecutive cases of bacterial meningitis in adults complicated by brain infarction. Primary causative organism were the Group B Streptococci in one case and the Streptococcus pneumoniae in other two cases. MRI, especially with FLAIR method and of coronal view, disclosed abnormal intensity areas near the brain surface. Conventional angiography and MR-angiography in the two cases showed tapering and stenosis of arteries. These cases suggest that routine use of MRI/ MRA in bacterial meningitis reveal neuro-vascular complications more frequently and easily. The benefits of adjunctive steroid therapy in the treatment of bacterial meningitis might be beneficial to suppression of these neurovascular complication cased by inflammatory vasculitis.
尽管有了新抗生素,但细菌性脑膜炎的死亡率以及患有细菌性脑膜炎后遗症的患者数量仍然居高不下。据报道,成人病例中脑血管并发症的发生率低于儿童病例。我们连续遇到3例成人细菌性脑膜炎合并脑梗死的病例。主要致病菌在1例中为B组链球菌,在另外2例中为肺炎链球菌。MRI,尤其是采用液体衰减反转恢复(FLAIR)序列和冠状位成像时,显示脑表面附近有异常强化区域。2例患者的传统血管造影和磁共振血管造影显示动脉逐渐变细和狭窄。这些病例表明,在细菌性脑膜炎中常规使用MRI/MRA能更频繁、更容易地发现神经血管并发症。辅助性类固醇疗法在治疗细菌性脑膜炎中可能有助于抑制由炎症性血管炎引起的这些神经血管并发症。