Stroke Complicating Pediatric Bacterial Meningitis: A Retrospective Case-Controlled Cohort Analysis

Bacterial meningitis is a life-threatening illness, with the complication of stroke having the capacity to cause significant further harm. The purpose of this study was to examine the incidence, presentation, investigation, treatment, and neurological outcome of stroke in the setting of pediatric bacterial meningitis.

A retrospective case-control study was conducted from January 1, 2012, to December 31, 2022, including children aged 0-15 years managed at a tertiary referral center in Auckland, New Zealand. Cases had laboratory-confirmed bacterial meningitis with stroke confirmed on neuroimaging. Controls were matched 1:1 by age and causative organism.

Among 540 patients with bacterial meningitis (median age <1 year; 62% male), stroke occurred in 72 (13%). Children with stroke were more often male (67% vs 53%) and from high-deprivation households (60% vs 42%). No clinical features at presentation predicted stroke and 52/72 (72%) deteriorated within 30 hours of admission (interquartile range: 13-96). Stroke cases had lower cerebrospinal fluid white cell counts and higher protein levels. Magnetic resonance imaging performed in 68/72 (94%) identified 59 arterial ischemic and 15 venous strokes. Antithrombotic therapy was used in 12/72 (17%) without hemorrhagic transformation. Stroke cases required longer intensive care and hospital stays and had higher morbidity and mortality.

Our large cohort confirms stroke following bacterial meningitis is associated with significant morbidity. There is a potential window for primary stroke prevention. Early neuroimaging should be sought and the role of antithrombotic and/or anti-inflammatory agents be given priority for future research to inform best practice.