Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study
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To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients.
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.
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).
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.
KeywordsBacterial meningitis Cerebral infarction Delayed cerebral thrombosis Complication Secondary deterioration
This research has been supported by grants from The Netherlands Organization for Health Research and Development [ZonMw; NWO-Vidi grant 2010 (016.116.358)] and the Academic Medical Center (AMC Fellowship 2008), and the European Research Council (ERC Starting Grant 2011).
Conflicts of interest
All authors declared that they have no conflicts.
- 6.Lucas MJ, Brouwer MC, Van De Beek D (2012) Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study. In: Proceedings of the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Francisco, 9–12 September 2012 (abstract L1–1223)Google Scholar
- 14.Klein M, Koedel U, Kastenbauer S, Pfister HW, Van De Beek D, Schut ES et al (2010) Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis: past as prologue: delayed stroke as a para infectious process of bacterial meningitis? Neurology 75:193–194PubMedCrossRefGoogle Scholar