Klebsiella meningoencephalitis presenting like embolic ischemic stroke

Wipfler, Peter; Pilz, Georg; Lesický, O; Golaszewski, Stefan; Ladurner, G.; Kraus, Jörg

doi:10.1007/s00415-009-0046-8

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Although tuberculous or fungal meningitis was initially suspected, cytological evidence of adenocarcinoma in the CSF led to a diagnosis of meningeal carcinomatosis. Nonbacterial thrombotic endocarditis (marantic endocarditis) and infective endocarditis [8] or bacterial meningoencephalitis [9] can present with fever and acute multiple cerebral infarctions. However, in the patient reported here, no vegetation was detected via transthoracic or transesophageal echocardiography, and the CSF bacterial culture was negative.…”

Section: Discussionmentioning

confidence: 99%

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

et al. 2014

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BackgroundMeningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported.Case presentationHerein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski’s sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis.ConclusionThe comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.

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Section: Discussionmentioning

confidence: 99%

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

et al. 2014

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“…There are only sporadic case reports of meningitis as stroke mimic mainly associated with the presence of interesting (mostly bacterial) isolates in the culture results [16][17][18][19][20][21][22][23][24][25]. Data from meta-analyses also identify a low incidence of meningitis among stroke mimics [1,2,[26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Aseptic meningoencephalitis mimicking transient ischaemic attacks

et al. 2013

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Purpose To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. Methods This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. Results A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Conclusions Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.

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Klebsiella meningoencephalitis presenting like embolic ischemic stroke

Cited by 2 publications

References 10 publications

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

Co-occurrence of multiple cerebral infarctions due to hypercoagulability associated with malignancy and meningeal carcinomatosis as the initial manifestation of gastric cancer

Aseptic meningoencephalitis mimicking transient ischaemic attacks

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