Cerebral infarction in bacterial meningitis: predictive factors and outcome

Abstract

In this study, we analysed the frequency, morphological patterns and clinical characteristics of cerebral ischaemia in bacterial meningitis. We sought to determine predictors for the development of vasculopathy and ischaemic infarction in patients with bacterial meningitis. Consecutive adult patients admitted between March 1998 and February 2009 to a neurological intensive care unit at a university hospital in Germany with the diagnosis of bacterial meningitis were included in the study. Standard criteria were used to define bacterial meningitis. From 68 patients with bacterial meningitis, six patients suffered from cerebral ischaemia (8.8%). In our cohort, reduced level of consciousness on admission (p = 0.01) and lower white blood cell (WBC) count in cerebrospinal fluid (CSF) (p = 0.012) were associated with development of ischaemic cerebrovascular complications. The short-term outcome of all patients was poor (median modified Rankin scale 4.5). In patients presenting with reduced level of consciousness on admission and/or low WBC count in CSF early cerebral imaging including MR angiography or CT angiography are warranted to detect impending cerebrovascular complications.

Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis

“…All patients presented with an impaired level of consciousness. On presentation, the median score on the Glasgow Coma Scale was 10 (range, [3][4][5][6][7][8][9][10][11][12][13]. Seven patients (47%) had focal neurological deficits on admission, mostly aphasia (n = 4) and/or hemiparesis (n = 4).…”

“…Poor outcome in bacterial meningitis is often caused by vascular complications, both in the systemic and central nervous system compartment [1]. Cerebrovascular complications are especially common in patients with pneumococcal meningitis, with arterial ischemic stroke in 10-29% of patients [3][4][5][6], cerebral venous sinus thrombosis in 9% [4], and intracerebral hemorrhage in 1-5% [3,4].…”

A Delayed Cerebral Vasospasm with Infarction Is Secondary to <i>Listeria monocytogenes</i> Meningitis: MRI and MRA Are Diagnostically Useful

“…A cerebral infarction is a severe complication of bacterial meningitis, reported as a result of vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. Only a few cohort studies on cerebral infarctions in bacterial meningitis have been published (5)(6)(7)(8). Cerebrovascular involvement, including cerebral infarction, is particularly common in pneumococcal meningitis (5, 9, 10) and typically occurs only in the acute phase of bacterial meningitis (11).…”

Syndrome de la queue de cheval après une méningite à Neisseria meningitidis de type C

“…La survenue d'AIC est plus classique puisque 8,8 % des méningites bactériennes sont compliquées d'ischémie céré-brale. Les mécanismes en cause sont la vascularite [4], le vasospasme, l'endocardite et les emboles septiques [5,6]. Les mécanismes avancés dans la survenue de péricardite après infection à Neisseria meningitidis sont une atteinte infectieuse avec péricardite purulente précoce ou une atteinte réactionnelle avec péricardite secondaire plus tardive [7].…”