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64 years old, male
.
4-year history of severe Listeria monocytogenes meningitis
.
This presentation was due to weakness in the proximal arm, while muscle strength in the distal face and lower extremities was preserved
.
Symptoms have developed slowly over the past 2 years
Physical examination showed barrel-man syndrome , with lesions confined to the center of the cervicothoracic spinal cord
.
Blood analysis was unremarkable, and cerebrospinal fluid analysis showed no recurrence of meningitis or persistent infection
barrel man syndrome
Spinal cord MRI showed isolated pockets of cerebrospinal fluid from C3 to C4, and the cerebrospinal fluid space from C3 to T12 disappeared
.
MRI showed tethered spinal cord, suggesting adhesive arachnoiditis
Figure 1.
(A and C) sagittal and axial MRI T2 sequences at the last diagnosis of L.
monocytogenes meningitis, (B and D) at the first bilateral upper extremity weakness 4 years later of sagittal and axial T2-weighted MRI sequences
.
Axial MRI (C) and (D) are the sites indicated by arrows in sagittal (A) and (B)
The final diagnosis was post-infectious adhesive arachnoiditis following bacterial meningitis, which was due to tethered spinal cord leading to central injury to the cervicothoracic spinal cord
Post-infectious adhesive arachnoiditis following bacterial meningitis, which is a central injury to the cervicothoracic spinal cord due to tethered spinal cord
Original source:
Original source:Philipp Karschnia, Leon Kaulen, Niklas Thon, et al.
Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms Leave a Comment here
