Neurosurgery Blog: Cerebral Infarction in Adults with Bacterial Meningitis

Abstract

Background

To evaluate clinical features and prognostic factors of cerebral infarctions in adults with community-acquired bacterial meningitis.

Method

An observational cross-sectional study, including 696 patients of whom 174 had cerebral infarction, from a prospective nationwide cohort of community-acquired bacterial meningitis (period, 1998–2002), confirmed by culture of cerebral spinal fluid (CSF) in patients aged over 16 years. Two investigators independently determined the presence of infarction.

Result

Cerebral infarction occurred in 174 episodes (25%), with a high inter-rater agreement for determining the presence of cerebral infarction (kappa 0.95). Cerebral infarctions occurred in 128 of 352 patients (36%) with pneumococcal meningitis, in 22 of 257 (9%) with meningococcal meningitis and in 24 of 87 patients (28%) with meningitis caused by other bacteria. Patients with infarctions were older (P < 0.001) and often presented with predisposing conditions, such as otitis and/or sinusitis (P = 0.001) or an immunocompromised state (P = 0.003) compared to those without infarction. Patients with infarctions presented with lower scores on the Glasgow Coma Scale (P < 0.001), lower CSF white cell counts (P = 0.001), and higher serum erythrocyte sedimentation rate (ESR) (P < 0.001). Unfavorable outcome occurred in 108 (62%) patients with infarctions. In a multivariate analysis, infarction was related with unfavorable outcome (odds ratio 3.37; 95% confidence interval 2.19–5.21; P < 0.001). We identified lower CSF white cell counts and high ESR to be independent risk factors for cerebral infarction.

Conclusion

Cerebral infarction is a common and severe complication in adults with community-acquired bacterial meningitis. Preventing cerebral infarctions will be important in reducing the high morbidity and mortality rate in adults with community-acquired bacterial meningitis.

Content Type Journal Article
Category Original Article
Pages 1-7
DOI 10.1007/s12028-011-9634-4
Authors
- Ewout S. Schut, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands
- Marjolein J. Lucas, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands
- Matthijs C. Brouwer, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands
- Mervyn D. I. Vergouwen, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands
- Arie van der Ende, Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Amsterdam, The Netherlands
- Diederik van de Beek, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands