Bacterial meningitis associated cerebral vasculitis: A case report and review of the literature

Abstract

Background: Bacterial meningitis is an infectious condition associated with high rates of morbidity and mortality. Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults. It is a highly fatal disease that often leaves survivors with serious neurologic damage if left untreated. Cerebral vasculitis is a rare but recognized complication of bacterial meningitis as seen in the literature. Patient and methods: We report a 55-year-old woman diagnosed with pneumococcal meningitis who developed cerebral vasculitis during her stay at the hospital. It was confirmed by cerebral magnetic resonance imaging (MRI) that showed multifocal ischemic lesions of the brain and the patient's neurologic symptoms resolved after the administration of corticosteroids and the patient made a full recovery. In addition to MRI, many investigations were done to rule out other possible causes of these lesions and confirm cerebral vasculitis post pneumococcal meningitis as a diagnosis in this case. Conclusion: Cerebral vasculititis should be considered in patients who deteriorate on treatment, with MRI remaining the mainstay of diagnosis. However, with the absence of a specific MRI sequence that could confirm the diagnosis of vasculitis, it remains a diagnosis of exclusion. Some patients experience rapid onset of neurological deterioration shortly after meningitis, while others show delayed symptoms. Steroids are found to be the mainstay of treatment for vasculitis in the majority of cases. More research to determine the dosage, timing and duration is required.