Posterior Cerebral Artery Occlusion Associated With Mycoplasma pneumoniae Infection

Abstract

Cerebral infarction is a rare complication of Mycoplasma pneumoniae infection. In all cases previously reported in the literature, vascular occlusion occurred in the anterior brain circulation, either the internal carotid or the middle cerebral artery. We report a case of a child with posterior cerebral artery occlusion and resultant hemiparesis associated with M. pneumoniae infection.

Central nervous system manifestations of Mycoplasma pneumoniae infections

“…However, concomitant risk factors for stroke confounded the association in some cases. 61,62 Finally in vitro release of a neurotoxin from some Mycoplasma species could contribute to neurologic injury 52 however, no such toxin has been demonstrated in humans infected with M. pneumoniae.…”

“…2,3,10,16 The interval between the onset of respiratory symptoms and neurologic manifestations had a range of 2-14 days. 13,26 M. pneumoniae infection has been associated with the development of several neurological findings indicative of focal or diffuse injury and there may be cerebellar involvement 3,6,8,9,22,26,40,41,48,50,51,53,[55][56][57][58][59][60][61][62][64][65][66][67][68][69][70][71][72] (Table 1). Encephalitis with or without meningeal involvement, aseptic meningitis, transverse myelitis and acute disseminated encephalomyelitis (ADEM), thromboembolic stroke, Guillain-Barre syndrome and radiculitis have all been reported (Table 1).…”

<i>Mycoplasma pneumoniae</i> in Elderly Patients with Stroke

“…It is interesting to note that most published cases [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28]reporting strokes associated with acute M. pneumoniae infection occurred mainly in paediatric or younger age groups of patients – a population with much less atherosclerotic burden. Indeed, the mechanisms postulated to link M. pneumoniae infection and stroke in these case reports included focal vasculitis, direct invasion of vessel wall, post-infectious autoimmune process, and intravascular hypercoagulable state, leading to cerebrovascular thromboembolic phenomena [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 31]. In fatal cases, cerebral pathology frequently combines capillary thromboses and microangiopathy, perivenular lymphocytic infiltrations and demyelination in perivascular location [28].…”

“…In addition, M. pneumoniae has also been detected in atherosclerotic specimens [11, 12, 13, 14]. Although M. pneumoniae is known to cause central nervous system diseases [5, 28, 31], specific association between M. pneumoniae and acute cerebrovascular disease was limited to case reports involving mainly younger patients [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28]. …”

“…Specifically, a positive association between M. pneumoniae infection and cerebrovascular disease has also been reported [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28]. These reports are limited to a number of clinical case studies involving mainly paediatric and younger patients.…”