Abstract
Light and electron microscopic studies were conducted on myonecrosis following cerebral arterial spasm in meningitis.
A 34-year-old female developed fever, headache and vomiting. Neurological examination revealed a drowsy state, nuchal stiffness and hemiparesis. Spinal puncture revealed a purulent fluid containing 1, 219/mm3 cells. She deteriorated steadily into semicoma 10 days after onset. Computerized tomography scan showed low density areas in bilateral basal ganglia and cerebellar hemispheres. Angiography showed vasospasm of the major cerebral arteries and vasodilatation of the left Sylvian arteries. Repeated angiography two months after onset showed a diffuse narrowing of these arteries. She died of uncal herniation 67 days after onset.
Autopsy two hours after death disclosed softening in the territories of spastic arteries. Microscopically, the circle of Willis showed concentric stenosis due to an intimal proliferation. The media was remarkably atrophied and fibrotic with an infiltration of polymorphonuclear leucocytes. Electron-microscopically, the media disclosed numerous degenerating or necrotic smooth-muscle cells. The degenerating cells showed dissolution of myofilaments with resultant fine granular or filamentous material. The necrotic cells were abundant in vacuoles, lysosomes and dense bodies. The cytoplasm was eventually replaced by cellular debris and numerous collagen fibrils.
