Background and aims Basal ganglia infarction is considered a complication of chronic refractory meningitis. In acute infection the basal ganglia are usually spared. Here we report an exceptional case of bilateral infarction of the basal ganglia in a child with acute S. pneumoniae meningoencephalitis.
Methods A 4 year old girl with a short history of fever and left sided otalgia presented with drowsiness in a referral hospital. Cerebral spinal fluid (CSF) examination showed pleocytosis (900 leucocytes/mm3)and immediately corticosteroids, ceftriaxone and acyclovir were started. Because of a rapid decline inconsciousness she was transferred to our tertiairy PICU centre.
Results Ad admission the girl had become unresponsive and was intubated. Her pupils were mid wide and non-reacting to light. Neurologic examination showed a bipyramidal syndrome with hypertonicity of the lower extremities, brisk deep tendon reflexes and bilateral positive Babinski’s. S.pneumoniae was cultured from CSF and blood. An MRI 4 days after admission showed bilateral sharply demarcated areas of high-signal intensity in the thalamus indicating infarction (Figure 1). In addition osteomyelitis of the tip of the petrous pyramid was observed. Her consciousness gradually improved with bilateral reactive pupils and spontaneous limb movements. Brainstem evoked response audiometry (BERA) of the left ear was negative. Gross motor deficits and impaired eye movements persisted.