BILATERAL GANGLIONIC HAEMORRHAGIC STROKE COMPLICATING SUSPECTED MENINGOCOCCAEMIA: A CASE REPORT

S.A. Omenai1, O.O. Okonkwo1, A.A. Salami1, A.A. Labaeka2 and C.A. Okolo1

  1. Department of Pathology, University College Hospital, Ibadan.
  2. Department of Paediatrics, University College Hospital, Ibadan.

Abstract

Haemorrhagic stroke in pyogenic meningitis is a rare complication accounting for about 2% of all complications1,2. It often results from disseminated intravascular coagulation, which is a complication of bacterial meningitis and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patient presenting with altered levels of consciousness to detect cerebrovascular complications.

Correspondence:

Dr. C.A. Okolo
Department of Pathology,
University College Hospital,
Ibadan
Email: clemabuokolo@yahoo.ca

Introduction

Meningitis is a severe infection of the leptomeninges caused by either viruses, bacteria, parasites or fungi. Mortality rates is as low as 2% in infants and children and as high as 20-30% in neonates and adults3. Cerebral vasculopathy is a complication of bacterial meningitis and ischaemic stroke is much more common than haemorrhagic stroke and it usually occurs during the acute phase of meningitis1,2,4,5. Bacterial meningitis remains a leading cause of mortality from infectious disease globally, and the neurologic complications associated with this disease is a major contributor to mortality associated with the disease6.

In the paediatric age groups, meningitis usually develop after an encapsulated bacteria which had colonised the nasopharynx are disseminated into the blood and through haematogenous route breech the blood-brain barrier and colonise the leptomeninges where they rapidly multiply7. The body’s immune system mounts a response against the microbes. Studies done in rabbits with C3 deficiency have demonstrated the importance of the complement system in meningitis.8. Genetic deficiencies in the important early response cytokines such as TNF-, IL-1 and IL-6 predisposes an individual to central nervous system infections that could also run a fulminant course8–11.

Cerebral vasculopathy in bacterial meningitis can occur from infection by varying organisms such as Streptococcus pneumonia, Neisseria meningitidis, Haemophilus influenza and Staphylococcus aureus4,7,12,13. Haemorrhagic stroke from bacterial meningitis is rare1,14. Various pathophysiological mechanisms have been proposed, and these includes focal hyper-perfusion from loss of cerebral autoregulation, disseminated intravascular coagulation (DIC), localized vasculitis, and microaneurysm formation1,5. This adverse event confers a worse prognosis on the meningitis with higher morbidity and mortality1,15. Early diagnosis of cerebrovascular event complicating meningitis, would allow for prompt surgical intervention to improve prognosis5.

We report the case of nine-year-old female child who presented and died within 24 hours of presentation from bilateral basal ganglia haemorrhages due to acute bacterial meningitis.