Noncompressive myelopathy in acute community‐acquired bacterial meningitis: Report of seven cases and review of literature

Author:

Drost Evelien H. G. M.1,Chekrouni Nora1,Brouwer Matthijs C.1ORCID,van de Beek Diederik1ORCID

Affiliation:

1. Department of Neurology Amsterdam Neuroscience, Amsterdam University Medical Centres, University of Amsterdam Amsterdam the Netherlands

Abstract

AbstractBackground and purposeBacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported.MethodsCases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community‐acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis.ResultsNoncompressive myelopathy was reported in seven of 3047 episodes of community‐acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17–77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2–28). Spinal magnetic resonance imaging showed T2‐weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44).ConclusionsNoncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits.

Funder

ZonMw

Publisher

Wiley

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