Noncompressive myelopathy in acute community-acquired bacterial meningitis: Report of seven cases and review of literature

Eur J Neurol, 2024 · DOI: 10.1111/ene.16447 · Published: August 4, 2024

Simple Explanation

Bacterial meningitis can lead to complications involving the spinal cord, although these are rare. This study investigates noncompressive myelopathy, a condition where the spinal cord is damaged without being compressed, in patients with bacterial meningitis. The researchers identified seven cases from a nationwide study in the Netherlands and reviewed existing literature to understand the characteristics, causes, and outcomes of this rare complication. The study found that noncompressive myelopathy is a severe complication that can lead to persistent neurological deficits despite improvements during hospital admission.

Study Duration

January 2006 to December 2023

Participants

Seven of 3047 episodes of community-acquired bacterial meningitis

Evidence Level

Not specified

Key Findings

1
Noncompressive myelopathy was reported in 0.23% of community-acquired bacterial meningitis cases.
2
Symptoms of spinal cord dysfunction typically appeared after a median of 9 days following hospital admission for bacterial meningitis.
3
Improvement of spinal cord function was noted in some patients, but all experienced persistent neurological deficits.

Research Summary

This study investigates noncompressive myelopathy as a rare but severe complication of community-acquired bacterial meningitis, identifying seven cases from a nationwide cohort and reviewing 15 additional cases from literature. The findings indicate that spinal cord dysfunction typically manifests days after the onset of meningitis, is not specific to one pathogen or risk factor, and is often accompanied by other neurological abnormalities. Although some patients showed improvement, most experienced persistent neurological deficits and unfavorable outcomes, suggesting a need for timely recognition and potential immunosuppressive treatment.

Practical Implications

Early Diagnosis

Prompt spinal MRI evaluation is essential when spinal cord dysfunction is suspected in patients with bacterial meningitis.

Potential Immunosuppressive Treatment

Patients with noncompressive myelopathy may benefit from immunosuppressive treatment, though further research is needed to determine the optimal approach.

Clinical Monitoring

Careful monitoring of patients with bacterial meningitis for delayed neurological complications is crucial.

Study Limitations

1
The study may underestimate the case number due to overlooking severe cases with rapid mortality or lack of improvement in consciousness.
2
The inclusion of case reports is subjected to publication bias.
3
Antibody tests (MOG-IgG and AQP4-IgG) were not performed, which could have provided additional diagnostic clues.

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