Parainfedious ADEM Due to Pneumococcal Meningitis: Case Report

Abstract

Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating condition of the central nervous system (CNS), usually developing after a viral infection, mainly exanthematous diseases. We reported a case of ADEM developed during bacterial meningitis in this article. A 20-year-old men was admitted to our clinic with confusion, convulsion, headache vomiting and findings of meningeal irritation. There was a minor head trauma in his history. At first, there was no focal neurologic deficit. Cerebral spinal fluid (CSF) analysis on admission revealed streptococcus pneumonia and suggested elevating of protein level and pleocytosis. Antibacterial theraphy was started for meningitis. A few days later, he noticed quadriparesia, bulber paralysis and soon fell into drowsy to comatose. There was a intracellar nonenhancement large lesion on first MRI. He was operated and the tumour was diagnosed as inactive cystic macroadenoma. But his consciousness become indistinct. CSF study revealed marked elevation of pleocytosis and immunglobulin-G level. The T2 weighed image of brain MRI showed multiple high intensity areas, mainly on white matter areas. It was considered that encephalomyelitis might have been related to previous streptococcal CNS infection as a immun reaction. He showed rapid partial clinic improvement in response to pulse corticosteroid theraphy. On the basis this case and a rewiev of the literature, we postulated two mechanism for the develpoment of the streptococcus pneumonia associated CNS disease causing meningitis and immune-mediated ADEM. This has obvious therapeutic implications. MRI is useful for the diagnosis and follow-up study of ADEM at similar condition.