title: Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study.
abstract: OBJECTIVE
  To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients.
  
  
  METHODS
  We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis included in a prospective nationwide study in The Netherlands performed from 2006 to 2012.
  
  
  RESULTS
  Delayed cerebral thrombosis occurred in 11 of 1,032 episodes (1.1%). CSF culture yielded Streptococcus pneumoniae in ten patients and Listeria monocytogenes in one. Adjunctive dexamethasone therapy was administered before or with the first dose of antibiotics in 9 of 11 patients; two patients were initially not treated with dexamethasone. All patients made good initial recovery, followed by sudden deterioration after 7-42 days. Cranial imaging studies showed multiple cerebral infarctions in all patients. The outcome was unfavorable in all but one patient. In an explorative analysis, patients with delayed cerebral thrombosis had eightfold higher complement C5a CSF concentrations on the diagnostic lumbar puncture as compared in those without delayed cerebral thrombosis (p = 0.04).
  
  
  CONCLUSIONS
  Delayed cerebral thrombosis is a rare but devastating complication of bacterial meningitis. Adjunctive dexamethasone therapy seems to predispose patients with bacterial meningitis to this complication. We found some evidence that this thrombotic complication is associated with activation of the complement system.
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marjolein J
authors.initials: MJ
authors.lastname: Lucas
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D020767:Intracranial Thrombosis / Q000453:epidemiology / Q000209:etiology*; D008089:Listeria monocytogenes / Q000302:isolation & purification; D008088:Listeriosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D013129:Spinal Puncture; D018709:Statistics, Nonparametric; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D003907:Dexamethasone