Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited.

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Serval ID
serval:BIB_9DB600B7915D
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited.
Journal
Swiss Medical Weekly
Author(s)
Darling K.E., Niederhauser J., Bervini D., Giulieri S., Daniel R.T., Bille J., Erard V.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2012
Volume
142
Number
w13697
Pages
1-5
Language
english
Notes
Publication types: Journal ArticlePublication Status: epublish
Abstract
Meningitis due to Streptococcus pneumoniae is a rare complication of trans-sphenoidal surgery. We present the case of a patient who developed pneumococcal meningitis with associated bacteraemia after elective endoscopic trans-sphenoidal resection of a pituitary macro-adenoma. After initial treatment with ceftriaxone and dexamethasone, the patient made a good recovery and dexamethasone was discontinued. Two days later the patient's condition deteriorated rapidly, presenting focal and diffuse neurological deficits. Cerebral MRI revealed widespread punctate ischaemic-type lesions affecting both anterior and posterior vascular territories bilaterally and involving features consistent with cerebral vasculitis. Antibiotic treatment was broadened to include meropenem and dexamethasone was restarted, but the patient remained in a comatose state and died 14 days later. Steroid treatment may play a dual role in this poorly characterised infectious complication of trans-sphenoidal pituitary surgery. This possibility is discussed and the options for prophylaxis are reviewed.
Pubmed
Web of science
Open Access
Yes
Create date
06/12/2012 18:52
Last modification date
09/04/2020 5:21
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