Acute Epidural Abscess Complicating Pneumococcal Meningitis in Adult
Acute Epidural Abscess Complicating Pneumococcal Meningitis in Adult
Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented a cauda equine syndrome with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging (MRI) of the spine demonstrated a suppurative collection at L2-L3. Surgical decompression was performed, and antibiotherapy was followed for eight weeks. Clinical improvement was progressive over eight months. New onset neurologic deficits in a patient with pneumococcal meningitis should raise suspicion of acute epidural abscess.
The neurological complications of bacterial meningitis include cerebrovascular involvement such as brain edema, hydrocephalus, seizures, hearing impairment, cranial nerve palsies, and hemiparesis or quadriparesis, and systemic complications such as septic shock, acute respiratory distress syndrome, or disseminated intravascular coagulation. Epidural abscess is a rare medical emergency, which may result in catastrophic and irreversible neurological damage if left untreated. However, acute spinal cord dysfunction is a very uncommon complication of bacterial meningitis. A few cases of spinal abscess involvement following pneumococcal meningitis in children have been described in the literature.
We report a rare case of cauda equina syndrome following spinal epidural abscess in an adult, with resultant flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction, associated with Streptococcus pneumoniae meningitis.
Abstract and Introduction
Abstract
Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented a cauda equine syndrome with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging (MRI) of the spine demonstrated a suppurative collection at L2-L3. Surgical decompression was performed, and antibiotherapy was followed for eight weeks. Clinical improvement was progressive over eight months. New onset neurologic deficits in a patient with pneumococcal meningitis should raise suspicion of acute epidural abscess.
Introduction
The neurological complications of bacterial meningitis include cerebrovascular involvement such as brain edema, hydrocephalus, seizures, hearing impairment, cranial nerve palsies, and hemiparesis or quadriparesis, and systemic complications such as septic shock, acute respiratory distress syndrome, or disseminated intravascular coagulation. Epidural abscess is a rare medical emergency, which may result in catastrophic and irreversible neurological damage if left untreated. However, acute spinal cord dysfunction is a very uncommon complication of bacterial meningitis. A few cases of spinal abscess involvement following pneumococcal meningitis in children have been described in the literature.
We report a rare case of cauda equina syndrome following spinal epidural abscess in an adult, with resultant flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction, associated with Streptococcus pneumoniae meningitis.
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