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Images in Neurology |

Vasculitic Presentation of Staphylococcal Meningitis

Paul Bentley, MRCP; Farzana Qadri, MBBS; Edward J. Wild, MRCP; Nicholas P. Hirsch, MRCP; Robin S. Howard, MRCP
Arch Neurol. 2007;64(12):1788-1789. doi:10.1001/archneur.64.12.1788.
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A 19-year-old man had a 3-day history of headache, vomiting, and confusion. At admission, he was agitated, with bilateral papilledema, splinter hemorrhages, conjunctival and palatal petechiae, and distal purpura (Figure, A). His temperature was 38.3°C; pulse rate, 94/min; and blood pressure, 95/57 mm Hg. The C-reactive protein level was 303 mg/mL (to convert to nanomoles per liter, multiply by 9.524). Computed tomographic scans of the brain revealed hemorrhagic infarction in the right parietal lobe. At lumbar puncture, the white blood cell count was 62/μL (to convert to × 109/L, multiply by 0.001) (30% polymorphonuclear leukocytes), protein concentration was 0.05 g/dL (to convert to grams per liter, multiply by 0.001), and plasma glucose concentration was 64%. The results of cerebrospinal fluid culture and meningococcus polymerase chain reaction were negative. Blood cultures grew Staphylococcus aureus that was sensitive to methicillin. Transesophageal echocardiograms on days 3, 5, and 6 showed no evidence of endocarditis.

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Patient with staphylococcal meningitis. A, Purpura evident during week 1. B, T2- and diffusion-weighted magnetic resonance images demonstrate infarctions (i indicates restricted diffusion) in the left side of the thalamus and the right side of the putamen. C, T2-weighted and gradient-echo magnetic resonance images demonstrate hemorrhages (h indicates susceptibility) in the right parietal lobe and deep white matter of the right frontal lobe.

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