Mansour Tarek R, Alam Yasaman, Dahbour Layth, Alnemari Ahmed, Jumaa Mouhammad, Schroeder Jason L
Department of Surgery, Division of Neurosurgery, The University of Toledo Medical Center.
Surgery / Division of Neurological Surgery, The University of Toledo Medical Center.
Cureus. 2017 May 19;9(5):e1264. doi: 10.7759/cureus.1264.
Stroke is the fifth leading cause of death and is responsible for approximately nine percent of all deaths worldwide. Cases of Streptococcus mutans (S. mutans-induced intracerebral hemorrhage as a result of bloodstream infections have seldom been reported. New reports show that bacteria with specific collagen binding proteins (CBPs), such as the Cnm type produced by S. mutans, may inhibit platelet aggregation and cause bleeding. In this article, we report on a 62-year-old man with a recent history of left frontal intracerebral hemorrhage (ICH) who presented to the emergency department after a fall due to suspected seizure while in rehabilitation. Computed tomography (CT) scan of the brain showed a right cerebellar hemorrhage with surrounding edema and mass effect on the fourth ventricle. A suboccipital craniotomy to evacuate the cerebellar ICH was completed without complication. Radiologic and angiographic assessments regarding the etiology of this patient's stroke did not reveal any evidence of vascular pathology or mycotic aneurysms to explain his recurrent intracranial hemorrhages. Through persistent patient and family interviews, it came to light that a few weeks prior to the patient's first ICH, he was diagnosed with a bloodstream infection by S. mutans Bacteremia is known to be associated with embolic stroke, but only recently has it been shown that bacteremia can also be implicated in hemorrhagic stroke. S. mutans of the k serotype have specific CBPs that are attracted to exposed collagen in previously damaged small vessel walls. These bacterial proteins can interrupt the blood clotting cascade through the prevention of platelet aggregation, increasing the risk of intracerebral hemorrhage.
中风是全球第五大死因，约占全球总死亡人数的9%。变形链球菌（S. mutans）所致血流感染引发脑出血的病例鲜有报道。新报告显示，带有特定胶原结合蛋白（CBPs）的细菌，如变形链球菌产生的Cnm型，可能会抑制血小板聚集并导致出血。在本文中，我们报告了一名62岁男性，近期有左额叶脑出血（ICH）病史，在康复期间因疑似癫痫发作跌倒后被送往急诊科。脑部计算机断层扫描（CT）显示右小脑出血，周围有水肿，对第四脑室有占位效应。进行了枕下开颅手术以清除小脑ICH，手术顺利完成，无并发症。关于该患者中风病因的影像学和血管造影评估未发现任何血管病变或真菌性动脉瘤的证据来解释其复发性颅内出血。通过持续对患者及其家属进行访谈发现，在患者首次发生ICH的几周前，他被诊断出患有变形链球菌血流感染。已知菌血症与栓塞性中风有关，但直到最近才发现菌血症也可能与出血性中风有关。k血清型的变形链球菌具有特定的CBPs，这些蛋白会被先前受损的小血管壁上暴露的胶原所吸引。这些细菌蛋白可通过阻止血小板聚集来中断凝血级联反应，从而增加脑出血的风险。
