Intensive Care Medicine

, Volume 39, Issue 5, pp 866–871

Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study

Authors

  • Marjolein J. Lucas
    • Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical CenterUniversity of Amsterdam
  • Matthijs C. Brouwer
    • Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical CenterUniversity of Amsterdam
    • Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical CenterUniversity of Amsterdam
Original

DOI: 10.1007/s00134-012-2792-9

Cite this article as:
Lucas, M.J., Brouwer, M.C. & van de Beek, D. Intensive Care Med (2013) 39: 866. doi:10.1007/s00134-012-2792-9

Abstract

Purpose

To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients.

Methods

We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis included in a prospective nationwide study in The Netherlands performed from 2006 to 2012.

Results

Delayed cerebral thrombosis occurred in 11 of 1,032 episodes (1.1 %). CSF culture yielded Streptococcus pneumoniae in ten patients and Listeria monocytogenes in one. Adjunctive dexamethasone therapy was administered before or with the first dose of antibiotics in 9 of 11 patients; two patients were initially not treated with dexamethasone. All patients made good initial recovery, followed by sudden deterioration after 7–42 days. Cranial imaging studies showed multiple cerebral infarctions in all patients. The outcome was unfavorable in all but one patient. In an explorative analysis, patients with delayed cerebral thrombosis had eightfold higher complement C5a CSF concentrations on the diagnostic lumbar puncture as compared in those without delayed cerebral thrombosis (p = 0.04).

Conclusion

Delayed cerebral thrombosis is a rare but devastating complication of bacterial meningitis. Adjunctive dexamethasone therapy seems to predispose patients with bacterial meningitis to this complication. We found some evidence that this thrombotic complication is associated with activation of the complement system.

Keywords

Bacterial meningitisCerebral infarctionDelayed cerebral thrombosisComplicationSecondary deterioration

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012