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Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?

Hyperdensity in the middle cerebral artery (MCA) or posterior cerebral artery (PCA) on non-contrast head CT, suggests the presence of a thrombus inside these vessels, often referred to as the “MCA sign” or “PCA sign” respectively. These two signs are classically associated with strokes secondary to...

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Autores principales: Mojumder, Deb Kumar, Toledo, John De
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064185/
https://www.ncbi.nlm.nih.gov/pubmed/24966558
http://dx.doi.org/10.4103/0976-3147.131666
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author Mojumder, Deb Kumar
Toledo, John De
author_facet Mojumder, Deb Kumar
Toledo, John De
author_sort Mojumder, Deb Kumar
collection PubMed
description Hyperdensity in the middle cerebral artery (MCA) or posterior cerebral artery (PCA) on non-contrast head CT, suggests the presence of a thrombus inside these vessels, often referred to as the “MCA sign” or “PCA sign” respectively. These two signs are classically associated with strokes secondary to cardiovascular etiologies and are only infrequently reported with other types of stroke. Whereas stroke is a recognized complication of pneumococcal meningitis hyperdense large vessel sign (in this case a combination of MCA and PCA) has not been previously reported. We report a case of rapidly progressive pneumococcal meningitis that presented as acute stroke involving large vessels in the vicinity of the circle of Willis in a patient with a history of non-Hodgkin lymphoma (NHL) in remission for 6 years. This patient had received a week of high dose steroids before admission. Head CT scan on admission showed the presence of hyperdense MCA and PCA signs. The patient rapidly deteriorated and a follow-up head CT revealed diffuse brain edema and increased density in the basal cisterns without evidence of sub arachnoid hemorrhage. Tc99m exametazime brain flow scan showed no intracerebral blood flow both supra and infratentorially. Steptococcus pneumoniae, NHL cells and high-dose steroid use can upregulate tissue factor synthesis and may have led to a hypercoagulable state via activation of the extrinsic pathway in the large intracerbral arteries.
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spelling pubmed-40641852014-06-25 Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus? Mojumder, Deb Kumar Toledo, John De J Neurosci Rural Pract Case Report Hyperdensity in the middle cerebral artery (MCA) or posterior cerebral artery (PCA) on non-contrast head CT, suggests the presence of a thrombus inside these vessels, often referred to as the “MCA sign” or “PCA sign” respectively. These two signs are classically associated with strokes secondary to cardiovascular etiologies and are only infrequently reported with other types of stroke. Whereas stroke is a recognized complication of pneumococcal meningitis hyperdense large vessel sign (in this case a combination of MCA and PCA) has not been previously reported. We report a case of rapidly progressive pneumococcal meningitis that presented as acute stroke involving large vessels in the vicinity of the circle of Willis in a patient with a history of non-Hodgkin lymphoma (NHL) in remission for 6 years. This patient had received a week of high dose steroids before admission. Head CT scan on admission showed the presence of hyperdense MCA and PCA signs. The patient rapidly deteriorated and a follow-up head CT revealed diffuse brain edema and increased density in the basal cisterns without evidence of sub arachnoid hemorrhage. Tc99m exametazime brain flow scan showed no intracerebral blood flow both supra and infratentorially. Steptococcus pneumoniae, NHL cells and high-dose steroid use can upregulate tissue factor synthesis and may have led to a hypercoagulable state via activation of the extrinsic pathway in the large intracerbral arteries. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4064185/ /pubmed/24966558 http://dx.doi.org/10.4103/0976-3147.131666 Text en Copyright: © Journal of Neurosciences in Rural Practice http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Mojumder, Deb Kumar
Toledo, John De
Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title_full Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title_fullStr Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title_full_unstemmed Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title_short Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?
title_sort hyperdense large artery sign in meningitis: a marker of ominous thrombogenic potential of pneumococcus?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064185/
https://www.ncbi.nlm.nih.gov/pubmed/24966558
http://dx.doi.org/10.4103/0976-3147.131666
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