Cranial nerve palsies and cerebral infarction in a Young infant with meningococcal meningitis

A previously healthy 30-day-old male infant became ill with fever, poor activity, and refusal to feed for 2 days. A cerebrospinal fluid examination revealed 7.15 × 10⁸ leukocytes/1 with 72% neutrophils, protein 4.6g/1, and glucose 7mg/dl. Neisseria meningitidis was isolated from the blood and cerebrospinal fluid. On the fourth day of hospitalization, the baby was found to have left oculomotor and facial palsies, which resolved gradually. He was treated with intravenous penicillin for 2 weeks. A repeat CSF examination revealed a high persisting protein level of 2.9g/1 and a computerized tomographic brain scan revealed a cerebral infarction in the bilateral frontal lobes. The treatment was extended to 4 weeks. No relapse of the infection was noted. This is the first case report of an infant with meningococcal meningitis complicated by cranial nerve palsies and cerebral infarction. This and previous reports, show that meningococcal meningitis at an extremely young age is associated with a greater risk of developing neurological complications.