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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

Nonenhanced brain computed tomography scan eight weeks after admission. Axial image shows significant nonobstructive hydrocephalus resulting in compression of cerebral parenchyma. There are hypodensities involving the periventricular regions and the frontal lobes bilaterally with associated cystic encephalomalacia, more on the right.
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fig3: Nonenhanced brain computed tomography scan eight weeks after admission. Axial image shows significant nonobstructive hydrocephalus resulting in compression of cerebral parenchyma. There are hypodensities involving the periventricular regions and the frontal lobes bilaterally with associated cystic encephalomalacia, more on the right.

Mentions: The episodes transiently responded to lorazepam and baclofen. Clonidine was started at 3 micrograms/kg/dose twice a day and increased to 5 micrograms/kg/dose, four times a day. The spells significantly responded to this therapeutic regimen, until eight weeks into the illness, when he developed episodes of severe irritability, sustained extensor posturing with generalized sweating, and bulging anterior fontanel. An urgent brain CT scan showed periventricular hypodensities, cystic encephalomalacia, and a nonobstructive hydrocephalus (Figure 3).


Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis.

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

Nonenhanced brain computed tomography scan eight weeks after admission. Axial image shows significant nonobstructive hydrocephalus resulting in compression of cerebral parenchyma. There are hypodensities involving the periventricular regions and the frontal lobes bilaterally with associated cystic encephalomalacia, more on the right.
© Copyright Policy
Related In: Results  -  Collection

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

fig3: Nonenhanced brain computed tomography scan eight weeks after admission. Axial image shows significant nonobstructive hydrocephalus resulting in compression of cerebral parenchyma. There are hypodensities involving the periventricular regions and the frontal lobes bilaterally with associated cystic encephalomalacia, more on the right.
Mentions: The episodes transiently responded to lorazepam and baclofen. Clonidine was started at 3 micrograms/kg/dose twice a day and increased to 5 micrograms/kg/dose, four times a day. The spells significantly responded to this therapeutic regimen, until eight weeks into the illness, when he developed episodes of severe irritability, sustained extensor posturing with generalized sweating, and bulging anterior fontanel. An urgent brain CT scan showed periventricular hypodensities, cystic encephalomalacia, and a nonobstructive hydrocephalus (Figure 3).

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