CENTRAL NERVOUS SYSTEM:
Gross examination of the brain in both fresh (Figures 6 & 7) and fixed (Figure 8) states revealed dull, opaque and focally hemorrhagic leptomeninges with extensive purulent exudates along the cerebral convexities, longitudinal fissure, dural cap, base of the brain and spinal cord (Figure 9). Extensive purulent exudates were also noted within the superior sagittal sinus, which appeared partially thrombosed. The brain was moderately edematous with no signs of herniation.
Microscopic examination of the brain and leptomeninges showed acute meningitis (Figures 10, 11 & 12), in addition to acute hypoxic encephalopathy with acute ischemic cell change in scattered neocortical neurons and subiculum (Figures 13 & 14). Early thrombosis of the superior sagittal sinus was also microscopically evident (Figure 15)
Microscopic examination of the spinal cord shows radiculitis (Figures 16 & 17) due to involvement of spinal nerves and nerve roots by the inflammatory exudate.
The lungs showed mild pulmonary edema, moderate emphysema, with bullae up to 2 cm, and focal scarring of the upper lobes of both lungs. Microscopic examination revealed the presence of multifocal acute pneumococcal pneumonia in the lower lobe of the left lung (Figures 18 & 19).