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Delayed cerebral thrombosis complicating pneumococcal meningitis: an autopsy study
Joo-Yeon Engelen-Lee1, Matthijs C Brouwer1, Eleonora Aronica2,3
1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Annals of Intensive Care
|February 11, 2018
Summary
Delayed cerebral thrombosis (DCT) following pneumococcal meningitis may stem from multiple factors including vascular inflammation and aneurysms. Bacterial components persist post-treatment, potentially triggering renewed inflammation.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Delayed cerebral thrombosis (DCT) is a severe complication after pneumococcal meningitis, despite initial recovery.
- The exact cause of DCT remains unclear, with theories including bacterial invasion, coagulation issues, or immune responses.
Purpose of the Study:
- To investigate the histopathological features and potential causes of DCT in pneumococcal meningitis patients.
Main Methods:
- Histopathological analysis of 4 DCT patients, compared to 8 non-DCT meningitis patients and 3 controls.
- Evaluation of vascular immunoglobulin (IgA, IgG, IgM) deposition via immunofluorescence.
- Detection of pneumococcal capsules using immunofluorescence.
Main Results:
- Meningitis patients exhibited meningeal and vascular inflammation with thrombosis and infarction.
- Two DCT patients had basilar artery aneurysms, unlike non-DCT patients.
- Pneumococcal capsules were detected in meninges for up to 35 days post-antibiotics, with significant IgM and IgG deposition in meningitis cases.
Conclusions:
- DCT in pneumococcal meningitis is likely multifactorial, involving vascular inflammation, thromboembolism, and infectious aneurysms.
- Persistent pneumococcal components may drive recurrent inflammation, especially after dexamethasone treatment.
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