Images in emergency medicine

Abstract

Abnormal head computed tomography (CT) after iatrogenic postmyelogram bacterial meningitis. Head CT was performed without contrast (Figure 1). The images show cerebral edema and abnormally increased attenuation of the cerebral gray matter (illustrated by red arrows but not limited to these 2 locations). Normally, in the absence of renal failure, a head CT 1 day after a myelogram should show no evidence of remaining contrast (Figure 2, normal comparison). Here, presumably as a result of meningeal inflammation, both blood-meningeal and blood-brain barriers have been disrupted. The cerebral gyri are edematous and efface the cerebral sulci, and the cerebral gray matter shows abnormally increased attenuation (hyperdense), reflecting the breakdown of the blood-brain barrier, with parenchymal imbibition of contrast. Images in emergency medicineAnnals of Emergency MedicineVol. 48Issue 1PreviewA 47-year-old otherwise healthy man underwent an uneventful cervical myelogram with Omnipaque for cervical radiculopathy. The following day, he presented to the emergency department with fever, confusion, and meningismus. He began receiving intravenous ceftriaxone, vancomycin, and dexamethasone for presumed meningitis. Cerebrospinal fluid cell count revealed 7,950 WBCs, with 89% neutrophils. Cerebrospinal fluid Gram’s stain showed Gram-positive diplococci, and culture grew γ hemolytic streptococcus, later identified as Streptococcus viridans. Full-Text PDF