Acute Bilateral Oculomotor Nerve Palsy in an Adult Patient with &lt;i&gt;Neisseria meningitidis&lt;/i&gt;

Senda, Joe; Adachi, Takeshi; Tago, M; Mori, Masaya; Imai, Hisao; Ogawa, Yasuhiro; Kawaguchi, Katsuhiro

doi:10.2169/internalmedicine.2098-18

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Particularly, oculomotor, abducens, facial, and glossopharyngeal cranial nerve disorders are often observed (7). Nevertheless, cranial nerve palsy in N. meningitidis infections is rarely described, and, to our knowledge, only a few cases in adult patients and one pediatric case have been reported in recent times (10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 94%

Case Report: Para-infectious cranial nerve palsy after bacterial meningitis

et al. 2022

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A 27-year-old woman was admitted to our hospital for fever, associated with headache, nausea, and vomiting, and she rapidly developed mild left facial nerve palsy and diplopia. Neurological examination revealed mild meningitis associated with bilateral VI cranial nerve palsy and mild left facial palsy. As central nervous system (CNS) infection was suspected, a diagnostic lumbar puncture was performed, which revealed 1,677 cells/μl, 70% of which were polymorphonuclear leukocytes. Moreover, multiplex PCR immunoassay was positive for Neisseria meningitidis, supporting the diagnosis of bacterial meningitis. Finally, IgG oligoclonal bands (IgGOB) were absent in serum and cerebrospinal fluid (CSF). Therefore, ceftriaxone antibiotic therapy was started, and in the following days, the patient’s signs and symptoms improved, with complete remission of diplopia and meningeal signs within a week. On the contrary, left facial nerve palsy progressively worsened into a severe bilateral deficit. A second lumbar puncture was therefore performed: the CSF analysis revealed a remarkable decrease of pleocytosis with a qualitative modification (only lymphocytes), and oligoclonal IgG bands were present. A new brain MRI was performed, showing a bilateral gadolinium enhancement of the intrameatal VII and VIII cranial nerves bilaterally. Due to suspicion of para-infectious etiology, the patient was treated with oral steroid (prednisolone 1 mg/kg/day), with a progressive and complete regression of the symptoms. We suggest that in this case, after a pathogen-driven immunological response (characterized by relevant CSF mixed pleocytosis and no evidence of IgGOB), a para-infectious adaptive immunity-driven reaction (with mild lymphocyte pleocytosis and pattern III IgGOB) against VII and VIII cranial nerves started. Indeed, steroid administration caused a rapid and complete restoration of cranial nerve function.

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Section: Discussionmentioning

confidence: 94%

Case Report: Para-infectious cranial nerve palsy after bacterial meningitis

et al. 2022

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“…In this case, we assumed that the cranial nerve involvement was due to her bacterial meningitis, something which is not unheard of in adults (despite being less common than in children). 6 However, as previously mentioned, COVID-19 is known to have a variety of neurological manifestations, and focal cranial nerve involvement has been reported in other viral illnesses (eg, influenza A). 7 Ultimately, we do not yet have enough information about this condition to be able to definitively say which will have caused the focal cranial nerve manifestations.…”

Section: Discussionmentioning

confidence: 96%

Bacterial meningitis and COVID-19: a complex patient journey

2021

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A woman in her 70s presented to the emergency department with fever, fluctuating cognition and headache. A detailed examination revealed neurological weakness to the lower limbs with atonia and areflexia, leading to a diagnosis of bacterial meningitis, alongside a concurrent COVID-19 infection. The patient required critical care escalation for respiratory support. After stepdown to a rehabilitation ward, she had difficulties communicating due to new aphonia, hearing loss and left third nerve palsy. The team used written communication with the patient, and with this the patient was able to signal neurological deterioration. Another neurological examination noted a different pattern of weakness to the lower limbs, along with new urinary retention, and spinal arachnoiditis was identified. After more than 10 weeks in the hospital, the patient was discharged. Throughout this case, there were multiple handovers between teams and specialties, all of which were underpinned by good communication and examination to achieve the best care.

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“…The important causes of third nerve palsy are posterior communicating artery aneurysm, stroke, diabetes mellitus, vasculitis, tumors, meningitis, and trauma [3][4][5][6][7]. If the underlying pathology is microvascular ischemia as in diabetes and vasculitis, the pupillary function is generally not affected because the autonomic parasympathetic fibers that cause pupillary constriction are located on the periphery of the cross-section of the nerve.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Complete Oculomotor Palsy in Tubercular Meningitis

Gaba

Gupta

Lamba

et al. 2020

Cureus

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A 20-year-old female presented to the emergency department with fever, anorexia, headache, and neck stiffness for two weeks with recent onset of diplopia and ptosis. She was found to have bilateral symmetrical and complete oculomotor palsy. The diagnosis of tubercular meningitis (TBM) was established on magnetic resonance imaging of the brain and cerebrospinal fluid examination. The oculomotor palsy was attributed to tubercular exudates along the ventral surface of midbrain. Although cranial nerves palsies are common in TBM, such a pattern is rarely seen and has been reported only in the context of tuberculoma in midbrain. She was treated with anti-tubercular therapy for nine months, but there was only partial recovery of the oculomotor function.

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Acute Bilateral Oculomotor Nerve Palsy in an Adult Patient with <i>Neisseria meningitidis</i>

Cited by 3 publications

References 22 publications

Case Report: Para-infectious cranial nerve palsy after bacterial meningitis

Case Report: Para-infectious cranial nerve palsy after bacterial meningitis

Bacterial meningitis and COVID-19: a complex patient journey

Bilateral Complete Oculomotor Palsy in Tubercular Meningitis

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