Cerebrovascular complications in bacterial meningitis

Bacterial meningitis is a life-threatening infectious disease affecting the membranes around the brain and spinal cord. Despite progress in prevention and management, the case fatality and neurological sequelae remain high. Cerebrovascular complications occur in about one-fourth of patients and are an important driver of poor outcome. A better understanding of the disease pathology in cerebrovascular complications in patients with bacterial meningitis is therefore of great importance. In this thesis we describe the clinical characteristics, the radiological characteristics, outcome and mortality rates in patients with cerebrovascular complications in bacterial meningitis, using two prospective nationwide cohort studies in The Netherlands. Chapter 2 describes cerebral venous thrombosis complicating bacterial meningitis. Chapter 3 describes the histopathological characteristics of cerebral venous thrombosis in patients with pneumococcal meningitis. In Chapter 4, we describe patients with bacterial meningitis and subarachnoid hemorrhage. In Chapter 5, we describe patients with bacterial meningitis complicated by intracerebral hemorrhage. In Chapter 6, we review the pathophysiology, incidence, clinical presentation, outcome, and clinical management of cerebrovascular complications in patients with bacterial meningitis. The most commonly described cerebrovascular complication is cerebral infarction. The following cerebrovascular complications are relatively rare: delayed cerebral thrombosis, intracerebral hemorrhage, cerebral venous thrombosis, and subarachnoid hemorrhage. The presence of cerebrovascular complications in patients with bacterial meningitis is associated with neurological sequelae, unfavorable outcome, and high mortality. In Chapter 7 we place the main findings of this thesis in a broader perspective and provide recommendations for future research and clinical practice.