Abstract Details

Title Case Report: Cerebral Infarction Following Hemophilus Influenzae Meningitis (HfluM) in a Vaccinated Elderly Female

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-012

Objective

To present a case of H. influenzae meningitis in a vaccinated 83-year-old female complicated by cerebral infarction with no other major stroke risk factors.

Background HfluM is rare in adults with an incidence of approximately 4% mainly affecting those with predisposing conditions such as ENT infections, CSF leakage, immunocompromised state, head trauma and/or neurosurgical procedures. Ischemic stroke has been reported as a complication HfluM in children. The underlying pathophysiology is unclear but has been postulated to be due to arteriospasm and/or increased inflammation leading to subsequent coagulopathy and/or vasculopathy.

Design/Methods NA

Results An 83-year-old female without significant stroke risk factors presented with nausea, vomiting, diarrhea, headache, ear pain, and malaise. CSF studies revealed WBC of 6467/mcl with a neutrophil predominance (86%), RBC of 5,000/mcl, glucose of < 2 mg/dL, and protein of 999 mg/dL. Blood and CSF cultures all yielded H. influenzae secondary to otitis media and mastoiditis. Thereafter, she underwent multiple procedures including bilateral myringotomy tube placements, right cortical mastoidectomy, and right frontal EVD for hydrocephalus. A brain MRI was performed due to her persistent lethargy revealing an acute ischemic infarction in the left midbrain-pons. Two weeks later, CT head revealed acute infarcts involving the superior and middle right cerebellum and inferior left cerebellum. Her stroke work up was otherwise unremarkable, including the absence vertebrobasilar stenoses/occlusions and absence of vegetations on her cardiac valves.

Conclusions Cerebral infarction is a relatively common complication of bacterial meningitis, affecting 9-25% of cases, and is more frequently associated with pathogens such as Streptococcus pneumoniae and Staphylococcus aureus. Cerebral infarction is also a relatively common complication of HfluM in the pediatric population. However, HfluM leading to cerebral infarction in an adult has not been previously reported. Neurologists should consider the possible increased risk of ischemic infarcts in elderly patients presenting with HfluM.

Authors/Disclosures
Kiana Moussavi, MD (Dartmouth Hitchcock Medical Center) PRESENTER	Dr. Moussavi has nothing to disclose.
Karen Beaty, MD (Dartmouth Hitchcock Medical Center)	Ms. Beaty has nothing to disclose.
Alexander P. Auchus, MD, FAAN (Dartmouth Geisel School of Medicine)	Dr. Auchus has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. Dr. Auchus has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms.

��ɫ��

��ɫ��