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Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis.

Safadieh L, Sharara-Chami R, Dabbagh O - Case Rep Med (2012)

Bottom Line: The diagnosis of paroxysmal autonomic instability with dystonia was established.The patient responded to clonidine, baclofen, and benzodiazepines.Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.

ABSTRACT
Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently resulting in severe neurological impairment. A seven-month-old child presenting with Streptococcus pneumoniae meningoencephalitis developed right basal ganglia and hypothalamic infarctions. Daily episodes of agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing were observed. The diagnosis of paroxysmal autonomic instability with dystonia was established. The patient responded to clonidine, baclofen, and benzodiazepines. Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis.

No MeSH data available.


Related in: MedlinePlus

Enhanced brain computed tomography scan nine days after admission. Axial image through the basal ganglia shows hypodensities involving the right head of the caudate and anterior aspect of the putamen (thick white arrow) as well as the right hypothalamus (thin white arrow) representing subacute infarcts. In addition, there is development of bilateral hemispheric hygromas.
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fig2: Enhanced brain computed tomography scan nine days after admission. Axial image through the basal ganglia shows hypodensities involving the right head of the caudate and anterior aspect of the putamen (thick white arrow) as well as the right hypothalamus (thin white arrow) representing subacute infarcts. In addition, there is development of bilateral hemispheric hygromas.

Mentions: A follow-up brain CT scan performed at day nine of hospitalization showed an increase in size of the left parietal lobe and bilateral frontal and temporal lobes hypodensities, and appearance of new right basal ganglia (right head of the caudate and anterior aspect of the putamen), and right hypothalamus hypodensities (Figure 2). A follow-up lumbar puncture performed on the same day revealed a normal opening pressure, negative cultures, and improvement in the CSF parameters (48 white blood cells/mm3, protein of 1.29 g/L and glucose of 47 mg/dL), indicating a good response to ongoing therapies.


Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis.

Safadieh L, Sharara-Chami R, Dabbagh O - Case Rep Med (2012)

Enhanced brain computed tomography scan nine days after admission. Axial image through the basal ganglia shows hypodensities involving the right head of the caudate and anterior aspect of the putamen (thick white arrow) as well as the right hypothalamus (thin white arrow) representing subacute infarcts. In addition, there is development of bilateral hemispheric hygromas.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475321&req=5

fig2: Enhanced brain computed tomography scan nine days after admission. Axial image through the basal ganglia shows hypodensities involving the right head of the caudate and anterior aspect of the putamen (thick white arrow) as well as the right hypothalamus (thin white arrow) representing subacute infarcts. In addition, there is development of bilateral hemispheric hygromas.
Mentions: A follow-up brain CT scan performed at day nine of hospitalization showed an increase in size of the left parietal lobe and bilateral frontal and temporal lobes hypodensities, and appearance of new right basal ganglia (right head of the caudate and anterior aspect of the putamen), and right hypothalamus hypodensities (Figure 2). A follow-up lumbar puncture performed on the same day revealed a normal opening pressure, negative cultures, and improvement in the CSF parameters (48 white blood cells/mm3, protein of 1.29 g/L and glucose of 47 mg/dL), indicating a good response to ongoing therapies.

Bottom Line: The diagnosis of paroxysmal autonomic instability with dystonia was established.The patient responded to clonidine, baclofen, and benzodiazepines.Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.

ABSTRACT
Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently resulting in severe neurological impairment. A seven-month-old child presenting with Streptococcus pneumoniae meningoencephalitis developed right basal ganglia and hypothalamic infarctions. Daily episodes of agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing were observed. The diagnosis of paroxysmal autonomic instability with dystonia was established. The patient responded to clonidine, baclofen, and benzodiazepines. Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis.

No MeSH data available.


Related in: MedlinePlus