Objective:

Background:

HfluM is rare in adults with an incidence of approximately 4% mainly affecting those with predisposing conditions such as ENT infections, CSF leakage, immunocompromised state, head trauma and/or neurosurgical procedures. Ischemic stroke has been reported as a complication HfluM in children. The underlying pathophysiology is unclear but has been postulated to be due to arteriospasm and/or increased inflammation leading to subsequent coagulopathy and/or vasculopathy. 

Design/Methods:

NA

Results:

An 83-year-old female without significant stroke risk factors presented with nausea, vomiting, diarrhea, headache, ear pain, and malaise. CSF studies revealed WBC of 6467/mcl with a neutrophil predominance (86%), RBC of 5,000/mcl, glucose of < 2 mg/dL, and protein of 999 mg/dL. Blood and CSF cultures all yielded H. influenzae secondary to otitis media and mastoiditis. Thereafter, she underwent multiple procedures including bilateral myringotomy tube placements, right cortical mastoidectomy, and right frontal EVD for hydrocephalus. A brain MRI was performed due to her persistent lethargy revealing an acute ischemic infarction in the left midbrain-pons. Two weeks later, CT head revealed acute infarcts involving the superior and middle right cerebellum and inferior left cerebellum. Her stroke work up was otherwise unremarkable, including the absence vertebrobasilar stenoses/occlusions and absence of vegetations on her cardiac valves. 

Conclusions:

Cerebral infarction is a relatively common complication of bacterial meningitis, affecting 9-25% of cases, and is more frequently associated with pathogens such as Streptococcus pneumoniae and Staphylococcus aureus. Cerebral infarction is also a relatively common complication of HfluM in the pediatric population. However, HfluM leading to cerebral infarction in an adult has not been previously reported. Neurologists should consider the possible increased risk of ischemic infarcts in elderly patients presenting with HfluM.