Extensive cortical infarctions post-acute meningoencephalitis: A case report with literature review

Abstract

Background: Central nervous infections can present with or be complicated by acute infarctions similar to those seen in acute ischaemic stroke. Multiple and extensive cortical infarctions is an uncommon complication of acute bacterial meningitis in the young adult population and is associated with a poor prognosis. Findings: We present a case of a 41year old male bar attendant with extensive cortical infarctions post-acute meningoencephalitis. He was referred to our facility with a history of sore throat, fever, headache, neck pain and irrational behaviour. Initial Brain Computerised Tomography scan (CT) at presentation was normal, however a throat swab had revealed non-haemolytic streptococci and Cerebrospinal fluid analysis showed growth of streptococcal species (spp.). He was commenced on empirical intravenous antibiotics. A repeat brain CT scan ordered for after a week on admission due to patient’s deteriorating state showed extensive multiple cortical and subcortical infarctions bilaterally involving the pons, cerebellar, and cerebral cortex. Despite intensive management, we lost the patient after eighteen (18) days on admission. Conclusion: The presence of multiple infarctions portends a worse prognosis and should prompt more vigilance in the management of such patients.