Cerebral infarction in adults with bacterial meningitis

Neurocrit Care. 2012 Jun;16(3):421-7. doi: 10.1007/s12028-011-9634-4.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cerebral Infarction / epidemiology*
  • Cerebral Infarction / microbiology*
  • Cohort Studies
  • Community-Acquired Infections / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Meningococcal / epidemiology
  • Meningitis, Pneumococcal / epidemiology
  • Middle Aged
  • Morbidity
  • Netherlands / epidemiology
  • Prognosis
  • Risk Factors
  • Severity of Illness Index