Ischemic Cerebrovascular Complications of Haemophilus influenzae Meningitis

Spinal cord dysfunction with quadriplegia complicating pneumococcal meningitis

“…Spinal cord dysfunction is a very rare complication of childhood bacterial meningitis There are several possible mechanisms for spinal cord damage in bacterial meningitis and indeed more than one mechanism may be involved at the same time Actual involvement of the cord with empyema or abscess formation is an important consideration but has not been demonstrated by myelography Acute spinal subdural haematoma formation after lumbar puncture causing transient or permanent neurological deficit has not been reported to complicate bacterial meningitis. but is nevertheless a major risk in children with impaired coagulation which in itself is a not infrequent concomitant of overwhelming sepsis In older patients constrictive spinal arachnoid adhesions have caused late onset slowly progressive cord dysfunction Vascular insufficiency resulting in ischaemic cord damage is probably responsible for the majority of cases of cord damage in bacterial meningitis Narrowing and occlusion of the cerebral vessels abnormal cerebral circulation patterns and ischaemic cerebral infarcts have been demonstrated by cerebral angiography and CT to occur in patients with bacterial meningitis [5][6][7] No such studies have been performed on the spinal cord circulation during meningitis, but there is an obvious potential for phlebitis and arterttis to occur with resultant disturbance of cord circulation Any severe hypoxia or drop in perfusion pressure can pose a threat to the spinal cord watershed zones, despite the fact that blood flow in the spinal cord during systemic arterial hypotension has been shown to be self-regulatory Spinal stroke has occurred in adults following profound hypotension mostly associated with transient cardiorespiratory arrest cardiac arrhythmias and myocardial infarction The resulting paralysis was profound but these patients showed considerable neurological recovery ultimately, presumably related to the transient nature of the hypotensive ischaemic episode…”

Neonatal Central Nervous System Infection

“…47 Neuroimaging is indicated if the clinical diagnosis is unclear, there is failure to respond to appropriate therapy, neurologic deterioration occurs, signs and symptoms of raised intracranial pressure develop, or persistent seizures or focal neurological deficits develop. 71,72 CT and MRI are the principal imaging tools for evaluating the infant with meningitis. Although MRI is the most sensitive imaging method in the detection of brain involvement, CT is often used as the first examination, especially in emergency situations.…”