脳幹梗塞を合併した髄膜炎の1例

A Case of Meningitis Complicated by Brainstem Infarction

Ⅰ．はじめに

　髄膜炎はときに脳梗塞を発症することが報告されているが小児例に多く，成人例は少ない^2-6,8-25)．さらに，脳幹梗塞は非常に稀である^{2-4,6,8-12,13,15-17,19,22-25)}．今回われわれは，成人発症髄膜炎の経過中，脳幹梗塞を併発し，四肢麻痺を認めた症例を経験したので，文献的考察を加え報告する．

　A rare case of meningitis complicated by brainstem infarction is reported. A 64-year-old, previously healthy female was admitted to our hospital because of a 1-week history of fever and headache. Cefdinir was orally administered for several days before admission. Analysis of cerebrospinal fluid (CSF) on admission showed a white blood cell (WBC) count of 9,013cells/μl (97% polynuclear cells), a protein level of 212.8mg/dl, and a glucose level of 3mg/dl. CSF culture was negative for bacteria, including tubercle bacilli, and fungi. A brain computed tomography (CT) scan on admission showed acute hydrocephalus. Six hours after admission, the patient developed tetraplegia. Diffusion-weighted magnetic resonance (MR) images on day 2 revealed elevated diffusion coefficients with high signal intensity in the pons and the medulla oblongata. MR angiography demonstrated a narrowing change of the cerebral arteries. Follow-up MR angiography two months after admission showed normalization of the cerebral arteries. The patient remained tetraplegic at eight months after admission. We speculated that brainstem infarction in our case might have been caused by vascultis or brain edema.