Acute Hydrocephalus Associated with Streptococcus anginosus Meningitis

Masako Sakurai; Takashi Watari; Itaru Nakamura; Kazunari Azuma; Hiroshi Homma

doi:10.12890/2022_003653

Acute Hydrocephalus Associated with Streptococcus anginosus Meningitis

Eur J Case Rep Intern Med. 2022 Nov 22;9(11):003653. doi: 10.12890/2022_003653. eCollection 2022.

Authors

Masako Sakurai¹, Takashi Watari^{2

3}, Itaru Nakamura⁴, Kazunari Azuma¹, Hiroshi Homma¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan.
² General Medicine Center, Shimane University, Shimane, Japan.
³ Division of Hospital Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
⁴ Department of Infection Prevention and Control, Tokyo Medical University, Tokyo, Japan.

Abstract

Introduction: Meningitis-related acute hydrocephalus is rare, challenging to diagnose, and has a high mortality rate.

Case description: Here we describe the case of a 76-year-old patient diagnosed with bacterial meningitis who developed acute hydrocephalus and subsequently died.

Discussion: Although meningitis-related acute hydrocephalus is usually non-occlusive, occlusive hydrocephalus may also occur. Moreover, worsening hydrocephalus despite cerebrospinal fluid drainage should prompt a diagnosis of obstructive hydrocephalus. In such conditions, potential management strategies include ventriculoperitoneal shunt and endoscopic third ventriculostomy.

Conclusion: In patients with meningitis-related hydrocephalus, worsening despite appropriate antibiotic administration, treatment may be complicated by ventriculitis and obstructive hydrocephalus, which can be fatal. If intracranial pressure is not medically controlled, bilateral decompression craniectomy should be considered as a potential management strategy.

Learning points: The extreme rarity of obstructive hydrocephalus caused by bacterial meningitis can lead to delayed diagnosis and treatment.Ventriculoperitoneal shunt and endoscopic third ventriculostomy are the indicated management strategies for early diagnosis of obstructive hydrocephalus.Bilateral decompression craniectomy may be an option in such cases.

Keywords: Acute hydrocephalus; Streptococcus anginosus; bacterial meningitis; non-obstructive hydrocephalus; obstructive hydrocephalus; septic shock.