title: Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children.
abstract: OBJECTIVE
  To assess the safety and efficacy of antithrombotic therapy (ATT) for secondary stroke prevention of childhood bacterial meningitis.
  
  
  METHODS
  A retrospective study of cases of stroke associated with bacterial meningitis in 2 pediatric hospitals during a period of 15 years. Patients were included in the study if they were between 28 days and 18 years of age and had at least 2 serial neuroimaging studies during the acute phase of their illness. The safety of ATT was assessed by the presence or absence of intracranial hemorrhage. Efficacy was assessed by the failure in preventing stroke recurrence. Neurologic outcome was determined by the last documented Pediatric Stroke Outcome Measure score.
  
  
  RESULTS
  Twenty-two cases of childhood bacterial meningitis complicated by stroke were identified. Six cases were treated with heparin after either initial or recurrent infarction. None of the cases receiving heparin had further recurrence. Aspirin (acetylsalicylic acid [ASA]) was started after the initial or after recurrent infarction in 10 cases. Four (40%) had infarctions on ASA; 3 of these patients subsequently received heparin. In the 14 cases in which no ATT was begun, 8 (57%) had further recurrence of infarction. None of the patients, whether receiving heparin or ASA, had intracranial hemorrhage.
  
  
  CONCLUSIONS
  In this small sample, heparin and ASA appeared to be safe in childhood bacterial meningitis complicated by stroke and may be effective in improving outcome. Heparin may be more effective than aspirin in preventing recurrent infarction.
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors: Cyrus
authors: C
authors: Boelman
authors: Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada.
authors: Manohar
authors: M
authors: Shroff
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors: Ivanna
authors: I
authors: Yau
authors: Division of Neurology, British Columbia Children's Hospital, Vancouver, Canada.
authors: Bruce
authors: B
authors: Bjornson
authors: Microbiology Division, Hospital for Sick Children, Toronto, Canada.
authors: Susan
authors: S
authors: Richrdson
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors: Gabrielle
authors: G
authors: deVeber
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors: Daune
authors: D
authors: MacGregor
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors: Mahendranathn
authors: M
authors: Moharir
authors: Division of Neurology, Hospital for Sick Children, Toronto, Canada. Electronic address: r.askalan@utoronto.ca.
authors: Rand
authors: R
authors: Askalan
mesh_terms: D000293:Adolescent; D001241:Aspirin / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000188:drug therapy*; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin