Acute flaccid paralysis due to myelopathy in childhood bacterial meningitis

Spinal cord damage is a rare neurological complication of bacterial meningitis. From 1988 to 2001, three of 186 pediatric patients with acute bacterial meningitis presented with acute flaccid paralysis due to myelopathy. The disease-onset ages and causative pathogens of the three patients were 2 days (group B streptococcus), 3 months (Streptococcus pneumoniae), and 13 years (Neisseria meningitidis), respectively. Spinal MR imaging was normal in the 13-year-old patient, who was left with mild residual motor weakness. Severe necrotizing myelitis and syringomyelia over the thoracic spinal cord were found in the other two younger patients. Both had severe paralysis at follow-up. All three patients required mechanical ventilation or vasopressor agents during antibiotic treatment for bacterial meningitis.