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Delayed cerebral thrombosis complicating bacterial meningitis.
Sofie Depoortere1, Jonas Toeback2, Sophie Lunskens3
1Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
Acta Clinica Belgica
|January 18, 2021
Summary
Delayed cerebral thrombosis, a serious complication of bacterial meningitis, often presents as altered consciousness and new brain infarctions. This condition carries a high mortality rate, underscoring the need for prompt diagnosis and treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Bacterial meningitis can lead to delayed cerebral thrombosis, a severe cerebrovascular complication.
- This case report details a patient with pneumococcal meningitis who developed delayed cerebral thrombosis.
- Delayed cerebral thrombosis presents as a clinical deterioration, typically a sudden decline in consciousness, more than 5 days after meningitis onset.
Observation:
- The patient experienced a decline in consciousness on day 8 of hospitalization for pneumococcal meningitis.
- Neurological condition worsened, with repeated brain imaging revealing extensive ischemic lesions.
- Despite high-dose corticosteroid treatment, the patient's outcome was fatal.
Findings:
- A literature review identified 28 cases of delayed cerebral thrombosis post-bacterial meningitis, with Streptococcus pneumoniae being the predominant pathogen (89%).
- Clinical deterioration, most commonly altered consciousness (83%) and hemiparesis (52%), occurred in all patients.
- Brain imaging consistently showed new infarctions (96%), and the overall mortality rate was 46%.
Implications:
- Early recognition of delayed cerebral thrombosis is crucial, necessitating careful diagnosis based on clinical presentation and neuroimaging, while excluding endocarditis.
- Empirical high-dose corticosteroid treatment is recommended upon suspicion of delayed cerebral thrombosis.
- The poor prognosis and high mortality rate associated with delayed cerebral thrombosis highlight the need for further research into its etiology and improved therapeutic strategies.
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