Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis
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There is a widely held belief that cerebral infarction after bacterial meningitis is always caused by vasculitis; however, evidence is weak. We hypothesized that diffuse cerebral intravascular coagulation is an additional explanation of cerebral infarction in patients with pneumococcal meningitis.
Sixteen brains of adults who died from pneumococcal meningitis were investigated. Clinical data were collected, and brain sections were scored for signs of inflammation and activation of coagulation. Patients with and without cerebral infarction on autopsy were compared.
In total, 38% of patients had focal neurological deficits. Patients died at a median of 7 days (range, 0–32 days) after admission. On autopsy, the nine patients (56%) with cerebral infarctions more often had arterial thrombosis (p = 0.04) than patients without infarction. Patients with infarction tended to have more inflammatory infiltrations of brain parenchyma, microvascular proliferation, small vessel vasculitis/endarteritis obliterans, blood clotting/vessel clogging, and venous thrombosis. None of the patients had large vessel vasculitis. Five patients had cerebral infarctions without vasculitis or endarteritis obliterans. Although four patients with cerebral infarctions had small vessel vasculitis or endarteritis obliterans, areas of infarction could not be localized to the blood flow distribution of these vessels. Blood clotting/vessel clogging was seen in all four patients with vasculitis or endarteritis obliterans, but this was also observed in 10 patients without vasculitis or endarteritis obliterans. None of the patients developed disseminated intravascular coagulation.
Our results suggest that diffuse cerebral intravascular coagulation is an additional explanation of cerebral infarction complicating pneumococcal meningitis.
- van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–59. CrossRef
- van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354:44–53. CrossRef
- Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series. Lancet Neurol. 2006;5:123–9. CrossRef
- Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003;126:1015–25. CrossRef
- Weststrate W, Hijdra A, de Gans J. Brain infarcts in adults with bacterial meningitis. Lancet. 1996;347:399. CrossRef
- Katchanov J, Heuschmann PU, Endres M, Weber JR. Cerebral infarction in bacterial meningitis: predictive factors and outcome. J Neurol. 2010;257:716–20. CrossRef
- Wertham F. The cerebral lesions in purulent meningitis. Arch Neurol Psychiatry (Chic). 1931;26:549–82.
- Cairns H, Russell DS. Cerebral arteritis and phlebitis in pneumococcal meningitis. J Pathol Bacteriol. 1946;58:649–65. CrossRef
- Buchan GC, Alvord EC Jr. Diffuse necrosis of subcortical white matter associated with bacterial meningitis. Neurology. 1969;19:1–9.
- Dodge PR, Swartz MN. Bacterial meningitis: a review of selected aspects. N Engl J Med. 1965;272:1003–10. CrossRef
- Weisfelt M, de Gans J, van der Poll T, van de Beek D. Pneumococcal meningitis in adults: new approaches to management and prevention. Lancet Neurol. 2006;5:332–42. CrossRef
- Levi M, van der Poll T, Buller HR. Bidirectional relation between inflammation and coagulation. Circulation. 2004;109:2698–704. CrossRef
- Weisfelt M, Determann RM, de Gans J, et al. Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis. J Infect. 2007;54:545–50. CrossRef
- van de Beek D, de Gans J. Dexamethasone, pneumococcal meningitis. Ann Intern Med. 2004;141:327.
- Schut ES, Brouwer MC, de Gans J, Florquin S, Troost D, van de Beek D. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology. 2009;73:1988–95. CrossRef
- Winkler F, Kastenbauer S, Koedel U, Pfister HW. Role of the urokinase plasminogen activator system in patients with bacterial meningitis. Neurology. 2002;59:1350–5.
- Pfister LA, Tureen JH, Shaw S, et al. Endothelin inhibition improves cerebral blood flow and is neuroprotective in pneumococcal meningitis. Ann Neurol. 2000;47:329–35. CrossRef
- Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhäupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42:1497–504.
- Scheinker IM. Leucoencephalitis associated with purulent leptomeningitis (meningoleucoencephalitis). J Neuropath Exp Neurol. 1945;4:164–71. CrossRef
- Abramowicz D, Pradier O, De Pauw L, et al. High-dose glucocorticosteroids increase the procoagulant effects of OKT3. Kidney Int. 1994;46:1596–602. CrossRef
- Barber AE, Coyle SM, Marano MA, et al. Glucocorticoid therapy alters hormonal and cytokine responses to endotoxin in man. J Immunol. 1993;150:1999–2006.
- Van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010;9:254–63. CrossRef
- de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56. CrossRef
- MacFarlane JT, Cleland PG, Attai ED, Greenwood BM. Failure of heparin to alter the outcome of pneumococcal meningitis. Br Med J. 1977;2:1522. CrossRef
- Izuhara Y, Yamaoka N, Kodama H, et al. A novel inhibitor of plasminogen activator inhibitor-1 provides antithrombotic benefits devoid of bleeding effect in nonhuman primates. J Cereb Blood Flow Metab. 2010;30:904–12. CrossRef
- Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis
Volume 13, Issue 2 , pp 217-227
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- Pneumococcal meningitis
- Cerebral infarction
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- Author Affiliations
- 1. Department of Neurology, H2-259, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- 3. Division of Medicine, Department of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- 2. Department of (Neuro) Pathology (DT), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands