Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis

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Mervyn D I Vergouwen1, Ewout S Schut, Dirk Troost

  • 1Department of Neurology, H2-259, Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.

Neurocritical Care
|June 8, 2010
PubMed
Abstract

Insights

Cerebral infarction in pneumococcal meningitis may be caused by diffuse cerebral intravascular coagulation, not just vasculitis. This study investigated brain tissue to understand the mechanisms behind stroke in meningitis patients.

Area of Science:

  • Neurology
  • Pathology
  • Infectious Diseases

Background:

  • Cerebral infarction following bacterial meningitis is often attributed to vasculitis, but evidence is limited.
  • This study explores diffuse cerebral intravascular coagulation as an alternative explanation for cerebral infarction in pneumococcal meningitis.

Purpose of the Study:

  • To investigate the role of diffuse cerebral intravascular coagulation in cerebral infarction in patients with pneumococcal meningitis.
  • To compare autopsy findings in patients with and without cerebral infarction.

Main Methods:

  • Analysis of 16 adult brains from patients deceased due to pneumococcal meningitis.
  • Assessment of clinical data and brain sections for inflammation and coagulation activation.
  • Comparison of patients with and without cerebral infarction.

Main Results:

  • 56% of patients had cerebral infarctions, often associated with arterial thrombosis (p=0.04).
  • Infarcted patients showed increased signs of inflammation, microvascular changes, and venous thrombosis, but not large vessel vasculitis.
  • Five patients had cerebral infarctions without vasculitis; in others, infarction localization was unclear.

Conclusions:

  • Diffuse cerebral intravascular coagulation is a significant additional explanation for cerebral infarction in pneumococcal meningitis.
  • The findings challenge the sole attribution of cerebral infarction to vasculitis in this condition.

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