DELAYED CEREBRAL THROMBOSIS AFTER INITIAL GOOD RECOVERY FROM PNEUMOCOCCAL MENINGITIS

To the Editor:

Schut et al.¹ reported 6 patients who had ischemic stroke 7–30 days after initially good recovery from pneumococcal meningitis (PM). All patients were treated with adjunctive corticosteroids. Based on autopsy findings in 2 patients, Schut et al. proposed that stroke is caused by delayed cerebral thrombosis—not by vasculitis—and possibly related to adjunctive corticosteroid therapy.

Stroke is a well-known complication of PM, but the definite timing of stroke onset and its association with initial therapy are unknown.² We reanalyzed data of 17 previously published patients with ischemic stroke complicating PM³ focusing on timing of stroke onset, initial corticosteroid therapy, and causes of stroke.

Median onset of stroke was 4 (0–50) days after initiation of therapy. In 5 cases, stroke occurred 6–10 days after initiation of antibiotic therapy and in another 5 cases after more than 10 days. CSF parameters had initially improved in all 10 patients with stroke occurring at least 6 days after therapy was started. However, most of them were severely affected. Seven out of 10 were still comatose or sedated and only 3 out of 10 were following commands at stroke onset. Signs of narrowing of cerebral arteries were detected in 8 out of 10 patients (2 of them receiving corticosteroids) by conventional angiography,^{5 …}