Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism
A 75-year-old woman was admitted to ICU with coma following Streptococcus pneumoniae meningitis with bacteremia. Her Glasgow Coma Scale (GCS) score fluctuated around 4 to 6 over the next four weeks. There was no evidence of increased intracranial pressure (ICP). Electroencephalogram (EEG) showed onl...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2018/9439021 |
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| author | Philippe Hantson Thierry Duprez |
| author_facet | Philippe Hantson Thierry Duprez |
| author_sort | Philippe Hantson |
| collection | DOAJ |
| description | A 75-year-old woman was admitted to ICU with coma following Streptococcus pneumoniae meningitis with bacteremia. Her Glasgow Coma Scale (GCS) score fluctuated around 4 to 6 over the next four weeks. There was no evidence of increased intracranial pressure (ICP). Electroencephalogram (EEG) showed only diffuse aspecific slowing. Impaired cerebral blood flow (CBF) autoregulation was suggested at transcranial Doppler (TCD). Repeated brain magnetic resonance imaging (MRI) examination failed to demonstrate venous thrombosis, arterial ischemic stroke, or brain abscesses but revealed diffuse but reversible cortical cytotoxic edema at diffusion-weighted (DW) sequences. The brain FDG-positron emission tomography (FDG-PET) showed diffuse cortical hypometabolism. The patient unexpectedly experienced a complete neuropsychological recovery the next few weeks. The suggested hypothesis to explain this unusual disease course could be a transient alteration of CBF autoregulation due to some degree of diffuse subcortical microangiopathy. A concomitant reduction of brain metabolism probably prevented the progression towards cortical irreversible ischemic damage. |
| format | Article |
| id | doaj-art-24867aa8fd064022b60e67d4e73f7b7b |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-24867aa8fd064022b60e67d4e73f7b7b2025-02-03T05:54:28ZengWileyCase Reports in Neurological Medicine2090-66682090-66762018-01-01201810.1155/2018/94390219439021Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical HypometabolismPhilippe Hantson0Thierry Duprez1Department of Intensive Care, Cliniques St-Luc, Université Catholique de Louvain, Brussels, BelgiumDepartment of Neuroradiology, Cliniques St-Luc, Université Catholique de Louvain, Brussels, BelgiumA 75-year-old woman was admitted to ICU with coma following Streptococcus pneumoniae meningitis with bacteremia. Her Glasgow Coma Scale (GCS) score fluctuated around 4 to 6 over the next four weeks. There was no evidence of increased intracranial pressure (ICP). Electroencephalogram (EEG) showed only diffuse aspecific slowing. Impaired cerebral blood flow (CBF) autoregulation was suggested at transcranial Doppler (TCD). Repeated brain magnetic resonance imaging (MRI) examination failed to demonstrate venous thrombosis, arterial ischemic stroke, or brain abscesses but revealed diffuse but reversible cortical cytotoxic edema at diffusion-weighted (DW) sequences. The brain FDG-positron emission tomography (FDG-PET) showed diffuse cortical hypometabolism. The patient unexpectedly experienced a complete neuropsychological recovery the next few weeks. The suggested hypothesis to explain this unusual disease course could be a transient alteration of CBF autoregulation due to some degree of diffuse subcortical microangiopathy. A concomitant reduction of brain metabolism probably prevented the progression towards cortical irreversible ischemic damage.http://dx.doi.org/10.1155/2018/9439021 |
| spellingShingle | Philippe Hantson Thierry Duprez Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism Case Reports in Neurological Medicine |
| title | Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism |
| title_full | Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism |
| title_fullStr | Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism |
| title_full_unstemmed | Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism |
| title_short | Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism |
| title_sort | late recovery from severe streptococcus pneumoniae comatose meningitis with concomitant diffuse subcortical cytotoxic edema and cortical hypometabolism |
| url | http://dx.doi.org/10.1155/2018/9439021 |
| work_keys_str_mv | AT philippehantson laterecoveryfromseverestreptococcuspneumoniaecomatosemeningitiswithconcomitantdiffusesubcorticalcytotoxicedemaandcorticalhypometabolism AT thierryduprez laterecoveryfromseverestreptococcuspneumoniaecomatosemeningitiswithconcomitantdiffusesubcorticalcytotoxicedemaandcorticalhypometabolism |