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Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Our results suggest that diffuse cerebral intravascular coagulation is an additional explanation of cerebral infarction complicating pneumococcal meningitis.

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Acknowledgments

Dr. M.D.I. Vergouwen was financially supported by an unrestricted grant from the Niels Stensen Foundation, The Netherlands.

Funding Information

This study was supported by grants from the Netherlands Organization for Health Research and Development [ZonMw; NWO-Veni 2006 grant 916.76.023 to DvdB]; the Academic Medical Center 2008 Fellowship [DvdB].

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Authors and 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

    Mervyn D. I. Vergouwen, Ewout S. Schut & Diederik van de Beek

  2. Department of (Neuro) Pathology (DT), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Dirk Troost

  3. Division of Medicine, Department of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Mervyn D. I. Vergouwen

Authors
  1. Mervyn D. I. Vergouwen
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  2. Ewout S. Schut
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  3. Dirk Troost
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  4. Diederik van de Beek
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Corresponding author

Correspondence to Diederik van de Beek.

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Vergouwen, M.D.I., Schut, E.S., Troost, D. et al. Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis. Neurocrit Care 13, 217–227 (2010). https://doi.org/10.1007/s12028-010-9387-5

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  • DOI: https://doi.org/10.1007/s12028-010-9387-5

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