case_images: PMC11753072_01
case_images: Timeline
case_images: 12883_2025_4033_Fig1_HTML.jpg
case_images: PMC11753072_01_12883_2025_4033_Fig1_HTML.jpg
case_images: Fig1
case_images: On arrival at our hospital (about 10 h later (Fig. 1)), the patient remained somnolent (GCS 13), displayed meningism, and was diagnosed with septic shock requiring vasopressors (systolic blood pressure of 100 mmHg with norepinephrine 0.8 mg/h, heart rate > 100/min, serum lactate 13 mmol/l and procalcitonin 3 microg/l).
case_images: 2a Macroscopic CSF fluid: turbid CSF detected at lumbar puncture indicating purulent meningitis. 2b: Axial MRI-DWI of the brain revealing diffusion restriction (arrow) indicating embolic stroke, highly suggestive of Austrian syndrome in the patient with pneumococcal meningitis and pneumonia
case_images: 12883_2025_4033_Fig2_HTML.jpg
case_images: PMC11753072_01_12883_2025_4033_Fig2_HTML.jpg
case_images: Fig2
case_images: A lumbar puncture was performed, revealing cloudy and turbid CSF fluid upon visual examination (Fig. 2a); 3064 cells/microl, 174 protein mg/dl and a low glucose of 35 mg/dl (glucose Index 0.22) (Table 1). Subsequent MRI of the brain revealed extra-axial small punctual restricted diffusion in terms of septic embolism without hydrocephalus, vein-thrombosis, empyema, cerebritis or ventriculitis (Fig. 2b).