Abdallah Mohamed A, Ahmed Khalid Mohamed, Recio-Restrepo Maria Victoria, Khalid Mowyad, Yeddi Ahmed, Abu-Heija Ahmad, Khalid Mazin
Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD.
Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI.
Ochsner J. 2020 Summer;20(2):219-221. doi: 10.31486/toj.18.0153.
Meningitis caused by is associated with devastating clinical outcomes. A considerable number of patients will develop long-term neurologic complications. Hearing loss, diffuse brain edema, and hydrocephalus are frequently encountered. Acute spinal cord dysfunction and polyradiculopathy can develop in some patients. A 63-year-old female was admitted to our hospital with sudden-onset bilateral lower extremity weakness. On admission, the patient had evidence of spinal cord dysfunction given the abnormal motor and sensory physical examination findings and the absent sensation with a sensory level at dermatome T4 on neurologic examination. Computed tomography myelography did not show evidence of spinal cord compression or transverse myelitis. Cerebrospinal fluid examination was positive for pneumococcal meningitis. The patient was treated with antibiotics and steroids. Nerve conduction studies demonstrated the absence of response, suggesting damage to the peripheral nerves and polyradiculopathy. The patient was treated with plasmapheresis for possible Guillain-Barré syndrome; however, she did not improve despite appropriate antibiotics, steroids, and plasmapheresis. She developed persistent quadriparesis, sensory impairments in upper and lower extremities, and bowel and bladder sphincter dysfunction. Our case demonstrates the development of spinal cord dysfunction (supported by the sudden onset of paraplegia and the presence of a sensory level) and polyradiculopathy (flaccid paralysis, ascending weakness, and absence of response in neurophysiologic studies suggesting severe damage to the peripheral nerves). The appearance of either complication is unusual, and the simultaneous occurrence of both complications is even more uncommon.
由……引起的脑膜炎与严重的临床后果相关。相当数量的患者会出现长期神经并发症。听力丧失、弥漫性脑水肿和脑积水很常见。一些患者会出现急性脊髓功能障碍和多发性神经根病。一名63岁女性因突发双侧下肢无力入院。入院时，鉴于运动和感觉体格检查结果异常以及神经检查中在T4皮节存在感觉平面且感觉缺失，患者有脊髓功能障碍的证据。计算机断层扫描脊髓造影未显示脊髓受压或横贯性脊髓炎的证据。脑脊液检查肺炎球菌脑膜炎呈阳性。患者接受了抗生素和类固醇治疗。神经传导研究显示无反应，提示周围神经损伤和多发性神经根病。患者因可能的吉兰 - 巴雷综合征接受了血浆置换治疗；然而，尽管使用了适当的抗生素、类固醇和血浆置换，她仍未改善。她出现了持续性四肢瘫、上下肢感觉障碍以及肠道和膀胱括约肌功能障碍。我们的病例显示了脊髓功能障碍（截瘫突然发作和感觉平面的存在支持）和多发性神经根病（弛缓性麻痹、进行性肌无力以及神经生理学研究中无反应提示周围神经严重损伤）的发生。任何一种并发症的出现都不常见，而两种并发症同时发生则更为罕见。
