Acute severe spinal cord dysfunction in bacterial meningitis in adults - MRI findings suggest extensive myelitis

Background: Bacterial meningitis is rarely complicated by acute spinal cord involvement leg, myelitis, ischemic infarction, spinal abscess, or epidura l hemorrhage). In spinal cord dysfunction, magnetic resonance imaging (MRI) is the imaging modality of choice. Still, MRI findings of myelitis due to bacterial meningitis in adults have not been reported. Methods: Spinal MRIs were obtained during the acute stage of meningitis and on follow-up in 3 adults with bacterial meningitis that was complicated by paraparesis or tetraparesis and bowel and bladder incontinence. The causat ive pathogens were Streptococcus pneumoniae and Neisseria meningitidis; in 1 patient, the pathogen was not identified. Results: In all cases, spinal MRI ruled out a compression of the cord by an extramedullary mass but demonstrated hyperintensities on T2-weighted image s that predominantly involved the gray matter and extended from the cervica l to the lumbar cord. Leptomeningeal and discrete nodular intramedullary en hancement on T1-weighted images was detected only in 1 patient. Follow-up e xaminations revealed that hyperintensities resolved completely in 1 patient , while a central cavitation developed in the cervical spinal cord of anoth er, and the MRI findings were progressive during the first 4 weeks in the t hird patient. In all cases, severe paresis and bowel and bladder incontinen ce persisted. Conclusion: We demonstrate for the first time the MRI findings of adults wi th acute spinal cord involvement during bacterial meningitis. Magnetic reso nance imaging showed central intramedullary hyperintensities on T2-weighted images that extended from the cervical to the lumbar cord, indicating myel itis. Clinical follow-up examinations suggest that myelitis during bacteria l meningitis has an unfavorable prognosis.