Title : Neonatal meningitis, the overlooked risk factor among adult-onset seizures: A case report
Abstract:
Introduction: While adult-onset seizures are commonly due to structural brain lesions, strokes, vascular abnormalities, or infections, there may be a less common etiology hiding within a patient’s neonatal history. Neonatal meningitis can cause seizures later in life; however, this is frequently overlooked. Considering this risk factor is of particular importance for patients presenting in the absence of an obvious seizure trigger, as there are often multiple mild risk factors, such as sleep deprivation, stress, fever, or medications, that become significant when combined.
Case Description: A 19-year-old female presented to the inpatient neurology consult team following a generalized tonic-clonic seizure. Her past medical history was significant for major depressive disorder managed with bupropion, and she had no known history of seizures, head injuries, or substance abuse. The witnessed seizure began suddenly with generalized, tonic-clonic movements lasting approximately one minute without loss of continence or tongue biting, which was followed by disorientation and confusion. The week prior to her seizure, she had experienced excessive stress and sleep deprivation but no fever, chills, or other signs of illness. Physical examination revealed disorientation and post-ictal confusion but was without nuchal rigidity. Vital signs and bloodwork were within normal range and unrevealing of seizure etiology, and subsequent brain MRI and EEG were unremarkable. Further inquiry revealed a history of bacterial meningitis at 6 weeks old, which often leaves neonates with lifelong complications such as seizures. Moreover, she had been prescribed the maximum dose of bupropion, an antidepressant known to increase seizure risk, for 5 consecutive years. Ultimately, her seizure was attributed to a lowered seizure threshold secondary to neonatal meningitis and high-dose bupropion, which was triggered by excessive stress and sleep deprivation.
Discussion: When investigating adult seizures, healthcare providers typically consider several aspects of a patient’s medical history such as recreational drug use, head injuries, and medications. However, a history of meningitis, particularly neonatal meningitis, is often overlooked in adult patients with new onset seizures despite its known association with seizures later in life. When patients present without an obvious trigger, the etiology of their seizure often involves multiple contributory factors, which individually may not be of concern. For example, while bupropion has been linked to seizures, most users will never suffer from a seizure. It is only in the presence of additional, compounding risk factors that a seizure may be of concern. Therefore, identifying all potential contributors after a seizure is crucial, as patients are usually fearful and anxious for answers. By considering all possible risk factors collectively rather than individually, including neonatal CNS infections, physicians may be better able to identify the cause of a patient’s seizure and facilitate this conversation. Furthermore, this approach may encourage physicians to educate their patients on lifestyle modifications to avoid seizure triggers, such as better sleep hygiene and avoidance of stress or recreational drugs; Physicians may also reconsider certain medications, such as bupropion, tricyclic antidepressants, and antipsychotics, in the presence of other seizure risk factors.
Audience Take Away Notes:
- Neonatal meningitis is a potential cause of seizures later in life and should be considered as an underlying risk factor, especially in the absence of other obvious seizure triggers.
- Patients presenting after seizures without obvious triggers usually have multiple contributing factors, and all possible underlying risk factors should be explored.
- While mild risk factors for seizures may not be on concern individually, physicians should consider them cumulatively when managing patients or investigating the cause of a seizure.
