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Delayed Cerebral Vasculopathy in Pneumococcal Meningitis: Epidemiology and Clinical Outcome. A Cohort Study

Lucía Boix-Palop1, Tamara Fernández2, Iván Pelegrín2

  • 1Infectious Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona; Universitat Internacional de Catalunya.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|June 13, 2020
PubMed
Abstract

Insights

Delayed cerebral vasculopathy (DCV) affects 10.5% of adult pneumococcal meningitis (PM) patients, leading to severe illness and poor outcomes. Further research is needed to understand the role of corticosteroids in DCV development.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Pneumococcal meningitis (PM) can lead to serious neurological complications.
  • Delayed cerebral vasculopathy (DCV) is a known but understudied complication of PM.
  • Understanding DCV prevalence and outcomes is crucial for patient management.

Purpose of the Study:

  • To determine the prevalence of DCV in adult patients with PM.
  • To describe the clinical characteristics and outcomes of DCV in this cohort.
  • To investigate the potential impact of systemic steroid exposure on DCV.

Main Methods:

  • Retrospective observational multicenter study of adult PM cases (2002-2015).
  • DCV diagnosis based on clinical, pathological, and radiological criteria.
  • Comparison of DCV patients versus non-DCV patients using univariate analysis.

Main Results:

  • 10.5% of 162 PM patients developed DCV (17 cases).
  • DCV patients presented with longer symptom duration, more frequent coma, lower CSF WBC counts, and higher CSF Gram stain positivity.
  • DCV was associated with significantly longer hospital stays, higher ICU admission rates, and more unfavorable outcomes (70.6% vs. 23.8%).
  • DCV onset occurred 1-8 days post-dexamethasone treatment.

Conclusions:

  • DCV is a significant complication of adult pneumococcal meningitis, affecting approximately one-tenth of patients.
  • Patients with DCV experience more severe illness and complicated recovery, with less than one-third recovering without disabilities.
  • The exact role of corticosteroids in the pathogenesis of DCV requires further investigation.
Keywords:
Cerebrovascular complicationDelayed cerebral vasculopathyDexamethasonePneumococcal meningitisVasculitis

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