J Neurocrit Care.  2021 Jun;14(1):57-60. 10.18700/jnc.210003.

Pneumococcal meningitis complicated by otomastoiditis and pneumocephalus confounding an acute ischemic stroke diagnosis

• Malinovic M
• Peterson J
• Lee F

• KMID: 2517134
• DOI: http://doi.org/10.18700/jnc.210003

Abstract

Background
Approximately one-fourth of admissions to stroke centers are diagnosed with non-stroke conditions or stroke mimics. Differentiating between these diagnoses and acute ischemic stroke is an important and time-sensitive task. The decision whether or not to administer thrombolytic therapy is also a critical component, and its safety has been studied numerous times.
Case Report
This case presents a patient with pneumococcal meningitis initially diagnosed as an acute ischemic stroke treated with thrombolytic therapy prior to further imaging.
Conclusion
Many stroke mimics such as migraines, infections, and seizures exist. Time is of the essence for the treatment of an acute ischemic stroke. The safety profile of tissue plasminogen activator has been studied numerous times in stroke mimics and shown to be relatively safe indicating if the patient has no contraindications for stroke intervention, treatment of stroke should not be extensively delayed to rule out stroke confounders.

Keyword

Meningitis; Ischemic stroke; Stroke; Stroke confounder; Stroke mimics

Figure

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  Fig. 1. Computed tomography angiography of the head and neck demonstrates complete opacification of the left mastoid air cells as well as left temporal pneumocephalus (circle) suspicious for acute otomastoiditis.

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  Fig. 2. Magnetic resonance imaging of the head demonstrates non-suppression of fluid-attenuated inversion recovery signal (circle) around the left temporal and left occipital lobes suspicious for meningitis.

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