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허혈뇌졸중과 경막하축농을 동반한 세균수막염

Bacterial Meningitis Accompanied with Subdural Empyema and Ischemic Stroke

Article information

J Korean Neurol Assoc. 2022;40(2):204-205
Publication date (electronic) : May 1, 2022
doi : http://dx.doi.org/10.17340/jkna.2022.2.23
Jun Ho Lee, MD, Kang Min Park, MD
Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
이준호, 박강민
인제대학교 의과대학 해운대백병원 신경과
Address for correspondence: Kang Min Park, MD Department of Neurlogy, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea Tel: +82-51-797-1195 Fax: +82-51-797-1196 E-mail: smilepkm@hanmail.net
received : December 27, 2021 , rev-recd : January 17, 2022 , accepted : January 17, 2022 .

59세 남자 환자가 1주일 전부터 시작된 발열, 두통 및 혼동으로 방문하였다. 시행한 뇌척수액검사에서 세균수막염에 합당한 소견이 확인되어 경험적 항생제 투여를 시작하였다. 입원 후 시행한 확산강조영상에서 좌측 측두엽 및 인접한 축외공간으로 고신호강도가 확인되어 경막하축농을 진단하였고(Fig. A), T1강조영상에서 좌측 측두엽의 뇌연화증을 동반한 뇌농양이 확인되었다(Fig. B). 10일 뒤 시행한 확산강조영상에서 속섬유막뒷다리에 이전에 보이지 않던 급성뇌경색이 관찰되었다(Fig. C, D). 고해상도 혈관벽 자기공명영상에서 좌측 원위부 내경동맥에서 중대 뇌동맥까지 조영 증강되는 다초점 협착이 있었다(Fig. E-G). 충분한 항생제 치료 후 추적 관찰한 6개월 후 뇌 자기공명혈관조영에서 혈관 병변의 호전이 확인되었다(Fig. H). 세균수막염에서 경막하축농, 뇌농양, 뇌경색이 동반된 증례를 보고하고자 한다[1,2].

Figure.

(A) Diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) shows high signal intensity lesions in the left anterior temporal lobe and adjacent cerebrospinal fluid space. (B) Gadolinium enhanced T1-weighted image shows central necrosis and ring enhancement suggesting abscess formation in the left anterior temporal lobe with leptomeningeal enhancement in Sylvian cistern. (C, D) DWI at the 10 days later reveals high signal intensity in left posterior limb of the internal capsule with high signal intensity on T2-weighted image, suggesting acute ischemic stroke (yellow arrow). (E, F) High resolution vessel wall MRI shows concentric narrowing with mild wall enhancement without intraluminal lesion at left distal internal carotid artery (white arrow). (G) Magnetic resonance angiography (MRA) reveals multifocal stenosis from left distal internal carotid artery to distal M1 segment (white arrowheads). (H) Follow-up MRA shows resolving state of multifocal stenosis.

References

1. Fugate JE, Lyons JL, Thakur KT, Smith BR, Hedley-Whyte ET, Mateen FJ. Infectious causes of stroke. Lancet Infect Dis 2014;14:869–880.
2. Siegel JL. Acute bacterial meningitis and stroke. Neurol Neurochir Pol 2019;53:242–250.

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Copyright © 2022 Korean Neurological Association

Figure.

Figure.

(A) Diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) shows high signal intensity lesions in the left anterior temporal lobe and adjacent cerebrospinal fluid space. (B) Gadolinium enhanced T1-weighted image shows central necrosis and ring enhancement suggesting abscess formation in the left anterior temporal lobe with leptomeningeal enhancement in Sylvian cistern. (C, D) DWI at the 10 days later reveals high signal intensity in left posterior limb of the internal capsule with high signal intensity on T2-weighted image, suggesting acute ischemic stroke (yellow arrow). (E, F) High resolution vessel wall MRI shows concentric narrowing with mild wall enhancement without intraluminal lesion at left distal internal carotid artery (white arrow). (G) Magnetic resonance angiography (MRA) reveals multifocal stenosis from left distal internal carotid artery to distal M1 segment (white arrowheads). (H) Follow-up MRA shows resolving state of multifocal stenosis.