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A Volumetric Method for Quantification of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage
Published on: July 28, 2018
Cerebral vasculitis as a complication of pneumococcal meningitis: A cohort study
Agathe Artiaga1, Fanchon Herman2, Caroline Arquizan3
1Infectious and Tropical Diseases Department - University Hospital of Montpellier, France.
Objective:
Cerebral vasculitis (CV) is a severe complication of pneumococcal meningitis (PM); whether dexamethasone use can reduce its occurrence remains to be determined.
Methods:
This is a retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020 in two tertiary hospitals. Extrapolating from a standardized definition of primary angiitis of the central nervous system, we defined CV as worsened neurological symptoms associated with compatible imaging. All images were analyzed by a radiologist, and two neurologists reviewed all inconclusive cases of suspected CV for adjudication. Factors associated with CV were analyzed, including dexamethasone use. A subgroup analysis was limited to patients with a lumbar puncture at PM diagnosis.
Results:
Among 168 patients with PM, 49 (29.2%) had CV, occurring after a median of 8 days (IQR 5-13) of PM diagnosis. In multivariate analysis (N = 151), initial CRP was associated with CV (OR 1.28 per 50-unit increase, p = 0.003), which was marginally linked with delayed hospital admission more than 48 hours after first symptoms (OR 2.39, p = 0.06) and prior NSAID intake (OR 2.94, p = 0.05). Dexamethasone administration did not impact CV occurrence. In 133 patients having undergone lumbar puncture, CSF protein level > 4.4 g/L (OR 4.50, p = 0.006) was associated with CV.
Conclusions:
In our cohort, CV was a frequent and severe complication of PM, often occurring in association with unduly delayed medical care, high CRP at admission, and high levels of protein in CSF.
Insights
Cerebral vasculitis (CV) is a frequent complication of pneumococcal meningitis (PM). Dexamethasone did not prevent CV, which was associated with delayed care and high inflammatory markers.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Cerebral vasculitis (CV) is a serious complication of pneumococcal meningitis (PM).
- The role of dexamethasone in preventing CV in PM patients is not well-established.
Purpose of the Study:
- To investigate the occurrence of CV in patients with PM.
- To identify factors associated with CV development, including dexamethasone use.
Main Methods:
- Retrospective, bicentric observational study of adult PM patients (2002-2020).
- CV defined by neurological worsening and compatible imaging; cases adjudicated by neurologists.
- Multivariate analysis identified factors associated with CV, including dexamethasone and CSF protein levels.
Main Results:
- CV occurred in 29.2% of PM patients, a median of 8 days post-diagnosis.
- High initial C-reactive protein (CRP) and CSF protein levels were associated with CV.
- Delayed hospital admission and NSAID intake showed marginal associations with CV; dexamethasone did not impact occurrence.
Conclusions:
- CV is a common and severe complication of PM.
- Delayed medical care, elevated CRP, and high CSF protein levels are associated with CV development.
- Dexamethasone administration did not reduce the incidence of CV in this cohort.
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