Cortical Venus Thrombosis ,a rare complication of Bacterial meningitis

Introduction: Community-acquired bacterial meningitis is most commonly caused by Streptococcus pneumonia and is associated with high mortality and morbidity rates. Neurological complications, e.g., hydrocephalus, seizures, and stroke occur frequently and are important determinants of outcome. Stroke has been described to occur up to ۳۰% of adults with bacterial meningitis, mainly consisting of cerebral infarctions. An uncommonly reported cerebrovascular complication of bacterial meningitis is cerebral venous thrombosis (CVT). Case Presentation: This is a case of ۱۵ year old woman who admitted to hospital complaint about severe headache, diplopia and right lower limb paresis. Two weeks prior to this presentation, she had experienced flu symptoms, headache, and ۱۰ days later, she developed diplopia which worsened despite referring to ophthalmologist. At presentation, she was ill and febrile. She had neck stiffness and right ۶th nerve palsy without any decrease in level of consciousness. Initial tests included leukocytosis(۲۳.۳ x۱۰۰۰/mm۳), high level of D-dimer(۴۰۸), C reactive protein(۲۰۶) and ESR(۷۲ mm/h). Brain CT just showed a mild hydrocephaly. Brain MRI pointed out an acute left parietal cortical restriction while brain MRV was normal suggestive of cortical venous thrombosis (CVT). In lumbar puncture (LP) procedure intracranial pressure (ICP) measured at ۴۵ cm-H۲O, cerebrospinal fluid (CSF) microscopy was not clear, showed increase in WBC count, protein level and a decrease in glucose level. A working diagnosis of meningitis was made. Following a lumbar puncture, she was treated empirically with infusion of acyclovir, Vancomycin and Ceftriaxone pending her CSF virology polymerase chain reaction (PCR) and bacterial culture. The result of PCR which came back negative after three days at which point the Acyclovir was stopped. Fever and ۶th nerve palsy improved following a ۱۴-day empirical therapy of bacterial meningitis. In further follow up with brain MRI, left parietal cortical restriction was disappeared. The patient was discharged with Topiramate, Acetazolamide and Rivaroxaban treatment.

کلیدواژه ها:

Meningitis ، Cortical venous thrombosis ، CVT