Abstract
A 34-year-old man initially presented with impaired consciousness and fever. Cerebral MRI showed hydrocephalus, ventriculitis and small recent cerebral infarcts. Pneumococcal meningoencephalitis was confirmed by lumbar puncture and blood cultures. Antibiotics were administered according to current guidelines, with rapid clinical improvement. Three months later, the patient was readmitted with acute aphasia (NIHSS 7), and imaging showed small ischemic lesions in the left MCA territory with multiple arterial stenosis involving mainly left carotid terminus and MCA, related to post-infectious vasculitis.