A case report on Meningitis complicated with Acute ischemic stroke and failed thrombolysis

Stroke is one of the rare but grave complication of meningitis with poor outcome and long-term sequalae, and the role of thrombolysis in infection-related stroke remains uncertain.A 52-year-old man presented with fever, headache, vomiting, and altered sensorium and on examination he had neck rigidity.He was treated empirically for meningitis with antibiotics and dexamethasone, showing initial improvement.But on day 9 th of admission, he developed acute right hemiparesis, dysarthria, and facial palsy.CT brain showed no haemorrhage, and he was thrombolysed with alteplase within 120 minutes of symptom onset.Despite timely thrombolysis, there was no neurological recovery.Repeat CT brain confirmed acute ischemic stroke involving the left middle cerebral artery territory.Advanced imaging and endovascular thrombectomy were unavailable.He was managed conservatively with antiplatelets, statins, and physiotherapy, resulting in partial recovery at discharge.Stroke associated with meningitis presents diagnostic and therapeutic challenges.Thrombolysis in such cases is controversial, and outcomes may be poor due to inflammatory thrombus burden.This case underscores the need for further research and highlights the limitations of stroke management in resource-limited settings. KEY CLINCIAL MESSAGEMeningitis can be complicated by acute ischemic stroke, posing both diagnostic and therapeutic challenges.This case demonstrates a failed thrombolysis despite timely intervention, underscoring the limitations in infection-related stroke management and need for research into effective strategies especially in resource-limited settings in absence of advanced imaging.