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drrathore
Paraplegia as a complication of Meningococcal meningitis
I would like to thank all my colleagues who participated in this discussion.Some more clarifications are as under
1.Paraplegia as a complication of pyogenic meningitis has been documented in literature but its rare.... so i presented it on this forum
2. This boy had and is still having flaccid paraplegia with 0/5 muscle power in lower limbs, areflexia, equivocal plantars and patolous anal tone.
3. As per his narrative and medical record... at the onsent of illness i.e on 2 nd April he had complete sensory loss to pinprick and touch below T 10.... This has improved to sensory impairment but there is a definite level
4. MRI were performed without contrast.... but still i would not bet on a paraspinal absess
5. EMG/NCS were performed in the 10 th week post illness and was suggestive of Acute Inflammatory Demyelinating polyneuropathy( But i am not convinced because of sphincter and sensory system involvement..... i have asked for a repeat EMG/ NCS)
6. Sadly he has been reviewed by great names in neurlogy both in Lahore and Rwp but they always considered TM and Carries spine and he underwent 03 CT Scan brains ( which were definitely not indicated , because of the flaccid nature of paraplegia) and EEG Brain ( which i again fail to understand). It was in Rwp that a neurophysician suspected Ant. Spinal Artey Thrombosis as a complication and advises Spinal Angiogram which was not done.
7. And to add a further depressing touch to the case... the patient or his family were never counsellled about the disease and every place they visited ended in spending thousands of rupees on investigations that were already available.
8. Any body interested in reviewing the MRI is most welcome
So THE MORAL OF THE CASE ( as i have understood)
1. If you are not sure of the diagnosis ,please consult a specialist colleague of that field
2. Always explain the patient and family whats wrong
? Dont take them as guine pigs
3. Last but not the least DONT ADVICE USELESS INVESTIGATIONS again and gain .... just to fill your pocket
[Edited by drrathore on 27-08-2006 at 07:34 AM GMT]
depressed
Re: Paraplegia as a complication of Meningococcal meningitis
Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings.
Am J Med Sci. 2002; 323(5):263-5 (ISSN: 0002-9629)
Bhojo AK; Akhter N; Bakshi R; Wasay M
Department of Neurology, The Aga Khan University, Karachi, Pakistan.
Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. Cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. Latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. Patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.
nizam
Re: Paraplegia as a complication of Meningococcal meningitis
As Dr Rathore indicated in the history this patient had Flaccid (not spastic) paraplegia with urinary and bowel incontinence and a sensory level at T11. The most likely differential diagnosis would include a paraspinal abscess. Cauda equina syndrome can not be ruled out. Polyradiculits secondary to meningiococcal meningitis is yet another possibility. If MRI was without gadolinium (contrast)these diagnosis can be easily missed. Based on the history of flaccid paralysis, transverse myelitis is very unlikely. An EMG in expert hands will be useful to rule out nerve root involvement.
yasir
Re: Paraplegia as a complication of Meningococcal meningitis
Sir, you are right that MS doesnt causes flaccid paralysis, but what could else be the cause of spastic paraplegia with normal MRI and CT. The signs that are mentioned by drrathore are suggestive of spastic paraparesis with spinothalamic tract and bladder / bowel involvement (at T11). I wonder what else could be the cause if upper limbs are normal and brain stem scan is also normal.
[Edited by yasir on 24-08-2006 at 08:01 AM GMT]
nizam
Re: Paraplegia as a complication of Meningococcal meningitis
Correction: I meant to say that multiple sclerosis does not cause flaccid parapleagia. It can cause spastic paraplegia.
Nizam
[Edited by Nizam on 23-08-2006 at 11:33 PM GMT]
[Edited by Nizam on 23-08-2006 at 11:37 PM GMT]
