To report a case of bihemispheric cortical infarcts in a patient with E.coli meningitis

Acute stroke occurs in 15-20% of patients with meningitis. Most existing studies have reported strokes with cryptococcal meningitis and tuberculous meningitis. The possible mechanisms are inflammatory vasculitis and vasospasm. Among bacterial; staphylococcus aureus and E.coli were found to be most virulent. There exists no report on the infarct distribution with E.coli meningitis.

A 25-year-old female presented with severe neck pain, headache and a reported fever of 101.4 at home. Patient has a complicated history of sacral myofibroblastic sarcoma involving multiple surgeries with most recent being an intrathecal pain pump placement a month ago. On arrival, Patient with stable vitals, was somnolent at first followed by a new onset seizure. Electroencephalogram showed mild generalized slowing with left temporal dysfunction and no epileptiform discharges. Neurologically, the patient was intact with no focal findings. MRI brain with contrast demonstrated multifocal cerebral and cerebellar cortically based non-enhancing diffusion restrictions representing cortical infarcts secondary to embolic phenomenon. There was susceptibility within these areas compatible with minimal microhemorrhages. Intrathecal pump was removed and a wound culture around the pump insertion site was positive for E.coli and candida parapsilosis. CSF revealed WBC 5781/ul, protein 578 mg/dl and glucose less than 30 mg/dl with culture positive for E.Coli. The patient was started on meropenem and fluconazole. CT angiogram head/neck was unremarkable for stenosis or dissection. TTE was normal with no vegetations. Overall, the patient made a good recovery with no neurological deficits.