• Neurocritical care · Jun 2012

    Cerebral infarction in adults with bacterial meningitis.

    • Ewout S Schut, Marjolein J Lucas, Matthijs C Brouwer, Mervyn D I Vergouwen, Arie van der Ende, and Diederik van de Beek.
    • Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 Amsterdam, The Netherlands.
    • Neurocrit Care. 2012 Jun 1; 16 (3): 421-7.

    BackgroundTo evaluate clinical features and prognostic factors of cerebral infarctions in adults with community-acquired bacterial meningitis.MethodAn 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.ResultCerebral 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.ConclusionCerebral 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.

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