Rare vascular complication of acute meningococcal meningitis
The following case has been reported in BMJ.

A 5-year-old boy presented with fever for 4 days and acute-onset weakness of the right upper and lower limb for 1  day. There was no history of headache, seizures, vomiting and altered sensorium, rash or bleeding from any site.

On examination, he had normal mentation, neck stiffness, Kernig’s sign, right-sided upper motor neuron facial palsy and right hemiparesis. The rest of the systemic examination was unremarkable. A clinical diagnosis of acute meningitis with left Middle Cerebral Artery (MCA) territory stroke was made.

Cerebrospinal fluid examination revealed 980 cells/µL (90% polymorphonuclear leucocytes and 10% lymphocytes), glucose 47 mg/dL, proteins 110 mg/dL and Neisseria meningitides antigen was positive; however, no organism could be isolated on microscopy and culture. He was unimmunised for meningococcal vaccine.

Blood culture was sterile. Detailed stroke and immune deficiency work-up was negative. MRI of the brain showed altered signal changes in left frontal lobe, anterior limb of the internal capsule, left caudate head and putamen (figure 1). MR angiography of intracranial vessels revealed attenuated left middle cerebral artery flow voids.

The child was started on intravenous ceftriaxone and oral aspirin in antithrombotic doses. At 6 months follow-up, he was asymptomatic and had no weakness.

Learning points
• Bacterial meningitis is a serious infection of central nervous system and Neisseria meningitides is one of the most common underlying aetiology.

• Post-meningitis vascular events are rare and usually present within the first week of illness and are commonly seen with Streptococcus pneumoniae.

• The treatment of vasculopathy includes oral aspirin in antithrombotic doses and heparin may be more effective in recurrent strokes or infarction.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-227069.full
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