2026 American Academy of Neurology Abstract Website

Objective:

To highlight a rare pediatric presentation of meningoencephalitis complicated by bilateral dural venous sinus thrombosis, CNS vasculitis, and multifocal posterior fossa infarcts, underscoring the diagnostic and therapeutic challenges in differentiating infectious from autoimmune etiologies.

Background:

Pediatric stroke secondary to central nervous system infection is uncommon. When compounded by venous sinus thrombosis, vasculitis, and evolving infarcts, timely recognition and multidisciplinary management are crucial for outcome optimization.

Design/Methods:

We present the clinical course, neuroimaging, and management of a previously healthy 14-year-old male with acute encephalopathy and hemiparesis, preceded by febrile illness and incomplete antibiotic treatment.

Results:

14-year-old male presented to hospital with left hemi-sensory deficits since the previous night. Initial evaluation revealed altered mental status, hemiparesis, and cranial neuropathies (CN-III, V, VI, VII). He had intermittent fevers, headaches, and early morning vomiting for a month, along with otitis media and partially treated streptococcal pharyngitis per father. MRI revealed restricted diffusion in the right thalamus, midbrain, and cerebellum with diffuse leptomeningeal enhancement, suggestive of infectious cerebritis and vasculitis. MRV confirmed left transverse and straight sinus thrombosis. CSF opening pressure was markedly elevated (55 mmHg) with neutrophilic pleocytosis and protein >300 mg/dL, though cultures and viral panels remained negative. Despite broad-spectrum antimicrobials and antivirals, the patient’s deficits progressed, prompting EVD placement for ICP control and anticoagulation initiation. Over subsequent weeks, neuroimaging demonstrated evolution of infarcts without new hemorrhage, while clinical status eventually improved with corticosteroids, long-term anticoagulation, and rehabilitation.

Conclusions:

This case illustrates the rare intersection of meningoencephalitis, venous sinus thrombosis, and CNS vasculitis in a pediatric patient, leading to multifocal posterior fossa infarcts. It emphasizes the need for early multimodal imaging, vigilance for secondary vascular complications in partially treated infections, and a multidisciplinary approach integrating infectious disease, neurology, hematology, and neurosurgery. Recognizing such overlapping pathologies may guide timely interventions and improve neurological outcomes in similar pediatric presentations.