An unusual presentation of meningitis as a consequence of inadvertent dural puncture

Infection as a complication of neuraxial blockade

“…Nevertheless, judging by the numbers of published cases, it could be the second commonest neurological complication of neuraxial analgesia in labour, after paraesthesiae. Loo et al 6 found 20 cases, 31,[43][44][45][46][47][48][49][50][51][52][53][54] while at least seven others [55][56][57][58][59][60][61] and one case of Herpes simplex encephalitis 62 among parturients, and dozens more among non-obstetric patients, have been reported since.…”

“…pneumoniae or H. influenzae). 6 Among the 27 obstetric cases, 12 followed spinals, 14,[43][44][45]49,57,58 seven followed CSE analgesia, 51,53,54,56,60,61 two followed accidental dural puncture 46,48 (one the woman who had two blood patches) 46 and six followed apparently uncomplicated epidurals (see below). Dural puncture seems necessary to allow entry of the less pathogenic streptococci to the subarachnoid space.…”

Meningitis after combined spinal-extradural anaesthesia in obstetrics

“…antibiotics and made a full recovery. Sansome, Barnes and Barrett reported a case of meningitis occurring on the third day after an accidental dural tap [4] and Berga and Trierweiler described a parturient who received extradural blood patch on two occasions after a dural tap with the extradural catheter and developed bacterial meningitis on the third day postpartum [5]. CSF cultures grew Streptococcus sanguis which is a commensal mouth organism.…”