Abstract Details

Title A Triple Intersection: Pediatric Meningoencephalitis Complicated by Venous Sinus Thrombosis, CNS Vasculitis, and Multifocal Infarcts

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-016

Objective To highlight a rare pediatric presentation of meningoencephalitis complicated by bilateral dural venous sinus thrombosis, CNS vasculitis, and multifocal posterior fossa infarcts, underscoring the diagnostic and therapeutic challenges in differentiating infectious from autoimmune etiologies.

Background Pediatric stroke secondary to central nervous system infection is uncommon. When compounded by venous sinus thrombosis, vasculitis, and evolving infarcts, timely recognition and multidisciplinary management are crucial for outcome optimization.

Design/Methods We present the clinical course, neuroimaging, and management of a previously healthy 14-year-old male with acute encephalopathy and hemiparesis, preceded by febrile illness and incomplete antibiotic treatment.

Results

14-year-old male presented to hospital with left hemi-sensory deficits since the previous night. Initial evaluation revealed altered mental status, hemiparesis, and cranial neuropathies (CN-III, V, VI, VII). He had intermittent fevers, headaches, and early morning vomiting for a month, along with otitis media and partially treated streptococcal pharyngitis per father. MRI revealed restricted diffusion in the right thalamus, midbrain, and cerebellum with diffuse leptomeningeal enhancement, suggestive of infectious cerebritis and vasculitis. MRV confirmed left transverse and straight sinus thrombosis. CSF opening pressure was markedly elevated (55 mmHg) with neutrophilic pleocytosis and protein >300 mg/dL, though cultures and viral panels remained negative. Despite broad-spectrum antimicrobials and antivirals, the patient’s deficits progressed, prompting EVD placement for ICP control and anticoagulation initiation. Over subsequent weeks, neuroimaging demonstrated evolution of infarcts without new hemorrhage, while clinical status eventually improved with corticosteroids, long-term anticoagulation, and rehabilitation.

Conclusions This case illustrates the rare intersection of meningoencephalitis, venous sinus thrombosis, and CNS vasculitis in a pediatric patient, leading to multifocal posterior fossa infarcts. It emphasizes the need for early multimodal imaging, vigilance for secondary vascular complications in partially treated infections, and a multidisciplinary approach integrating infectious disease, neurology, hematology, and neurosurgery. Recognizing such overlapping pathologies may guide timely interventions and improve neurological outcomes in similar pediatric presentations.

Authors/Disclosures
Nicholas Briski, MD (JFK Medical Center) PRESENTER	Dr. Briski has nothing to disclose.
Shrinjay A. Vyas, MD (JFK Medical Center)	Dr. Vyas has nothing to disclose.
Nancy Gadallah, DO (JFK Neuroscience Institute at JFK Medical Center)	Dr. Gadallah has nothing to disclose.
Daniel Bandari, MD (MS Center of California)	The institution of Dr. Bandari has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Bandari has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD-Serono. The institution of Dr. Bandari has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Bandari has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD-Serono. The institution of Dr. Bandari has received research support from Genentech. The institution of Dr. Bandari has received research support from EMD-Serono.

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