Kachuei Maryam, Zare Ramin, Sayyahfar Shirin, Khalili Mitra, Movahedi Hamidreza, Naghshbandi Mobin, Eghdami Shayan
Firoozabadi Clinical Research Development Unit (FACRDU), School of Medicine, Iran University of Medical Sciences.
Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences.
Ann Med Surg (Lond). 2024 Jan 22;86(3):1739-1744. doi: 10.1097/MS9.0000000000001749. eCollection 2024 Mar.
Bacterial meningoencephalitis is a serious infection affecting the brain and its surrounding membranes. While imaging studies play a crucial role in diagnosing this condition, the typical radiological findings are well-documented. However, this case report describes an unusual imaging presentation that deviates from the expected patterns, emphasizing the need for awareness of such variations.
A 7-year-old female with no prior medical history was referred to our hospital with fever, seizure, and loss of Consciousness. She had mild flu a week before admission. The duration of seizure episodes were 2-3 min, with tonic-clonic uncontrollable jerky movements. Brudzinski and Kernig signs were positive and plantar reflex was upward bilaterally in the physical examination. The computed tomography (CT) scan showed brain ventriculomegaly/hydrocephalus, and MRI findings indicated multiple foci located at cerebellum, basal ganglia, and thalamus alongside intensely restricted diffusion of the layering debris, suggesting pyogenic ventriculitis. Cerebrospinal fluid (CSF) analysis showed severe hypoglycorrhachia, despite non-significant increase of protein. The patient was undergone antibiotic therapy with ceftriaxone, vancomycin and rifampin, resulting in normalization of CSF values.
This case report highlights the importance of recognizing and interpreting unusual imaging presentations of bacterial meningoencephalitis in paediatric patients. It emphasizes the need for a comprehensive diagnostic approach, including clinical evaluation, laboratory tests, and imaging studies, to ensure accurate diagnosis and appropriate management of this potentially life-threatening condition. Further research and awareness of atypical imaging findings are warranted to enhance our understanding and improve patient outcomes.
细菌性脑膜脑炎是一种影响大脑及其周围脑膜的严重感染。虽然影像学检查在诊断这种疾病中起着关键作用，但其典型的放射学表现已有充分记录。然而，本病例报告描述了一种不同于预期模式的异常影像学表现，强调了认识此类变异的必要性。
一名既往无病史的7岁女性因发热、癫痫发作和意识丧失被转诊至我院。入院前一周她患了轻度流感。癫痫发作持续时间为2 - 3分钟，伴有强直性阵挛性无法控制的抽搐运动。体格检查中布鲁津斯基征和克尼格征阳性，双侧巴氏征向上。计算机断层扫描（CT）显示脑室扩大/脑积水，磁共振成像（MRI）结果表明在小脑、基底神经节和丘脑有多个病灶，同时分层碎片的扩散明显受限，提示化脓性脑室炎。脑脊液（CSF）分析显示严重低糖血症，尽管蛋白质无显著增加。该患者接受了头孢曲松、万古霉素和利福平的抗生素治疗，脑脊液值恢复正常。
本病例报告强调了认识和解读小儿细菌性脑膜脑炎异常影像学表现的重要性。它强调了需要一种全面的诊断方法，包括临床评估、实验室检查和影像学研究，以确保对这种潜在危及生命的疾病进行准确诊断和适当管理。有必要进一步研究并提高对非典型影像学表现的认识，以增进我们的理解并改善患者预后。
