Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis

Vergouwen, Mervyn D.I.; Schut, Ewout S.; Troost, Dirk; Beek, Diederik van de

doi:10.1007/s12028-010-9387-5

Cited by 77 publications

(78 citation statements)

References 26 publications

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“…The massive clotting may result in the local depletion of coagulation factors, which together with microvascular damage, vasculitis, and cerebral infarction might lead to the increased risk of ICH. 25 The proportion of patients with CVT and an infection treated with the therapeutic dose of heparin (82.5%) is similar to that of the entire ISCVT cohort (83.3%). 26 Apparently, most neurologists believe that heparin is indicated and safe in these patients although there is no evidence from randomized trials for the use of heparin in patients with a septic CVT.…”

Section: Discussionmentioning

confidence: 62%

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Zuurbier

Coutinho

Stam

et al. 2016

Stroke

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Background and Purpose-Local infections of the head or neck are a cause of cerebral venous thrombosis. Treatment of infectious cerebral venous thrombosis with heparin is controversial. We examined whether this treatment was associated with intracranial hemorrhagic complications and poor clinical outcome. Methods-We retrieved data from a prospective cohort study of 624 cerebral venous thrombosis patients. We compared patients with and without an infection of the head or neck and anticoagulated versus not anticoagulated. We examined death or dependency and new intracerebral hemorrhages. Results-Six hundred four of 624 patients were eligible for the study. Fifty-seven patients had an infection of the head or neck (9.4%). Comparing data between infection and noninfection patients, the frequency of therapeutic doses of heparin was similar in both groups (82.5% versus 83.7%). New intracerebral hemorrhages were more common in patients with an infection (12.3% versus 5.3%; P=0.04), but death or dependency did not differ between patients with and without an infection (15.8% versus 13.7%). In patients with an infection of the head or neck, there was no significant difference in the frequency of new intracerebral hemorrhages and poor outcome between patients who did or did not receive therapeutic doses of heparin. Conclusions-New intracerebral hemorrhages were more frequent in patients with an infection. The use of therapeutic doses of heparin did not seem to influence the risk of new intracranial hemorrhages or poor clinical outcome, but the number of patients who did not receive anticoagulation was too small to draw firm conclusions about safety of heparin in adults with cerebral venous thrombosis and an infection of the head or neck.

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Section: Discussionmentioning

confidence: 62%

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Zuurbier

Coutinho

Stam

et al. 2016

Stroke

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“…The relation between C5a and coagulation pathways is reciprocal: thrombin directly cleaves C5 and generates active C5a, and thrombin-activatable carboxypeptidase B inhibits C5a (43,45). The procoagulant activity of C5a may represent an additional and/or additive factor in the vascular occlusion process in bacterial meningitis (24,46,47). Second, C5a increases vascular permeability, thereby contributing to meningitis-induced brain edema.…”

Section: Figurementioning

confidence: 99%

Complement component 5 contributes to poor disease outcome in humans and mice with pneumococcal meningitis

Woehrl¹,

Brouwer²,

Murr³

et al. 2011

J. Clin. Invest.

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100

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Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. Additionally, SNPs in genes encoding complement pathway proteins have been linked to susceptibility to pneumococcal infection, although no associations with disease severity or outcome have been established. Here, we have performed a robust prospective nationwide genetic association study in patients with bacterial meningitis and found that a common nonsynonymous complement component 5 (C5) SNP (rs17611) is associated with unfavorable disease outcome. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis. Consistent with these human data, C5a receptor-deficient mice with pneumococcal meningitis had lower CSF wbc counts and decreased brain damage compared with WT mice. Adjuvant treatment with C5-specific monoclonal antibodies prevented death in all mice with pneumococcal meningitis. Thus, our results suggest C5-specific monoclonal antibodies could be a promising new antiinflammatory adjuvant therapy for pneumococcal meningitis.

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“…Local bacteria invasion might also play a role in the vascular events in patients with bacterial meningitis, triggering the spread of procoagulant and antifibrinolytic agents, leading to intraparenchymal edema and intravascular coagulation. 3,6 A significant association between recent infection and cervical artery dissection was previously described. 8,9 In our patient, it is possible that the pneumococcal infection contributed to the development of the internal carotid and vertebral arteries dissections, although we cannot exclude the hypothesis that the endotracheal intubation, with hyperextension of the neck, might have played a role.…”

Section: Discussionmentioning

confidence: 95%

Pneumococcal Meningitis, Cerebral Venous Thrombosis, and Cervical Arterial Dissection

Panício

Foresto

Mateus

et al. 2012

The Neurohospitalist

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Background: Pneumococcal meningitis in adults is widely associated with intracranial complications, which occur in up to 74.7% of the patients. Method: Case report. Results: We report the case of a 40-year-old white female with pneumococcal meningitis after a sinus surgery, who developed a concomitant cerebral venous thrombosis and multiple cervical artery dissections. Following treatment with antibiotics and intravenous heparin, she had complete neurological recovery. Conclusions: Vascular complications should always be remembered and adequately treated in patients with bacterial meningitis. Cervical arterial dissections should be investigated as potential embolic sources of intracranial ischemic lesions.

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Diffuse Cerebral Intravascular Coagulation and Cerebral Infarction in Pneumococcal Meningitis

Abstract: Our results suggest that diffuse cerebral intravascular coagulation is an additional explanation of cerebral infarction complicating pneumococcal meningitis.

Cited by 77 publications

References 26 publications

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Complement component 5 contributes to poor disease outcome in humans and mice with pneumococcal meningitis

Pneumococcal Meningitis, Cerebral Venous Thrombosis, and Cervical Arterial Dissection

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