Download PDF
Neuropediatrics 2018; 49(03): 213-216
DOI: 10.1055/s-0038-1635075
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Cystic Encephalomalacia following Vasculopathy and Vasospasm of Proximal Intracranial Arteries Due to Pneumococcal Meningitis in a Infant

Alexander Pschibul
1   Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
,
Wibke G. Janzarik
1   Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
,
Peter Franck
1   Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
2   Department of Neurology and Neuroscience, University of Freiburg, Freiburg, Germany
,
Markus Hufnagel
3   Department of General Pediatrics, Adolescent Medicine and Neonatology, University of Freiburg, Freiburg, Germany
,
Christopher Beck
4   Department of Neuroradiology, University of Freiburg, Freiburg, Germany
,
Rudolf Korinthenberg
1   Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

29 August 2017

17 January 2018

Publication Date:
09 March 2018 (online)

    Permissions and Reprints

Abstract

Despite the availability of modern antibiotics, pneumococcal meningitis in both children and adults remains a severe disease—one known to frequently cause grave complications and residual disability. Although the appearance of arterial vasospasms in bacterial meningitis systematically has been investigated and reported on for adult patients, such research is lacking when it comes to infants. We report on a 4-week-old infant who, 6 days after onset of pneumococcal meningitis, suffered severe neurological deterioration with treatment-resistant seizures and coma. Generalized cortical and subcortical edema developed in conjunction with diminished cerebral blood flow, as depicted in magnetic resonance angiography and serial Doppler-sonographic examinations. The ischemia resulted in extensive cystic encephalomalacia. We propose that the degree of variation in cerebral blood flow in the acute phase was the result of an extensive arterial vasculopathy involving vasospasms. Awareness of this complication and prospective serial Doppler-sonographic examinations may improve our understanding of the connection between brain edema and vasculopathy. At present, however, no effective treatment appears available.

Keywords

vasospasm - infarct - vasculopathy - Streptococcus pneumoniae - infant - meningitis - brain edema

Supplementary Material

 

  • References

  • 1 Klobassa DS, Zoehrer B, Paulke-Korinek M. , et al. The burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Eur J Pediatr 2014; 173 (07) 871-878
    CrossrefPubMedGoogle Scholar
  • 2 Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister HW. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care 2011; 15 (06) R281
    CrossrefPubMedGoogle Scholar
  • 3 Bode H, Wais U. Age dependence of flow velocities in basal cerebral arteries. Arch Dis Child 1988; 63 (06) 606-611
    CrossrefPubMedGoogle Scholar
  • 4 Deeg KH. Gehirn. In: Hofmann V, Deeg KH, Hoyer PF. , eds. Ultraschalldiagnostik in Pädiatrie und Kinderchirurgie: Lehrbuch und Atlas. 3rd ed. Stuttgart: Georg Thieme Verlag; ; 1989, 2005: 25-27
    Google Scholar
  • 5 Welch K. The intracranial pressure in infants. J Neurosurg 1980; 52 (05) 693-699
    CrossrefPubMedGoogle Scholar
  • 6 Hedlund G, Bale J, Barkovich AJ. Infections of the developing and mature nervous system. In: Barkovich AJ, Raybaud C. , eds. Pediatric Neuroimaging. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012: 954-993
    Google Scholar
  • 7 Widder B, Görtler M. Doppler- und Duplexsonographie der hirnversorgenden Arterien. 6th ed. Berlin, Heidelberg: Springer-Verlag; 2004
    Google Scholar
  • 8 Pfister HW, Feiden W, Einhäupl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 1993; 50 (06) 575-581
    CrossrefPubMedGoogle Scholar
  • 9 Jan W, Zimmerman RA, Bilaniuk LT, Hunter JV, Simon EM, Haselgrove J. Diffusion-weighted imaging in acute bacterial meningitis in infancy. Neuroradiology 2003; 45 (09) 634-639
    CrossrefPubMedGoogle Scholar
  • 10 Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 1989; 100 (1-2): 12-24
    CrossrefPubMedGoogle Scholar
  • 11 Burch CM, Wozniak MA, Sloan MA. , et al. Detection of intracranial internal carotid artery and middle cerebral artery vasospasm following subarachnoid hemorrhage. J Neuroimaging 1996; 6 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 12 Bode H, Harders A. Transient stenoses and occlusions of main cerebral arteries in children--diagnosis and control of therapy by transcranial Doppler sonography. Eur J Pediatr 1989; 148 (05) 406-411
    CrossrefPubMedGoogle Scholar
  • 13 Iijima S, Shirai M, Ohzeki T. Severe, widespread vasculopathy in late-onset group B streptococcal meningitis. Pediatr Int 2007; 49 (06) 1000-1003
    CrossrefPubMedGoogle Scholar
  • 14 Rabinstein AA, Lanzino G, Wijdicks EF. Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol 2010; 9 (05) 504-519
    CrossrefPubMedGoogle Scholar
  • 15 Taqui A, Koffman L, Hui F. , et al. Intra-arterial vasodilator therapy for parainfectious cerebral vasospasm. J Neurol Sci 2014; 340 (1-2): 225-229
    CrossrefPubMedGoogle Scholar