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Updated: Jun 19, 2026
06:01
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis
E S Schut1, M C Brouwer, J de Gans
1Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
Neurology
|November 6, 2009
Summary
Delayed cerebral thrombosis can occur after pneumococcal meningitis, even with initial good recovery. This suggests a potential dexamethasone-associated immunologic reaction targeting cerebral blood vessels, leading to poor outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Community-acquired acute bacterial meningitis can present with diverse clinical courses.
- Pneumococcal meningitis is a common cause of bacterial meningitis.
Observation:
- A case series of 6 patients with pneumococcal meningitis treated with dexamethasone showed initial recovery followed by sudden deterioration.
- Patients developed delayed cerebral infarctions, particularly in the thalamus and brainstem, despite sterile cerebrospinal fluid cultures.
- Autopsies revealed thrombosis in penetrating arteries without evidence of vasculitis.
Findings:
- Delayed cerebral thrombosis is a potential complication in pneumococcal meningitis, possibly linked to dexamethasone treatment.
- The pathology suggests an immunologic response targeting cerebral vasculature.
- This clinical course differs from previously reported cases of delayed vasculopathy.
Implications:
- Clinicians should consider delayed cerebral thrombosis in patients with pneumococcal meningitis who experience sudden neurological decline after initial recovery.
- The role of dexamethasone in the pathogenesis of these thrombotic events warrants further investigation.
- Understanding this complication may lead to improved management strategies for bacterial meningitis.
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