Q J Med 2003; 96: 755-762
© 2003 Association of Physicians
Cerebral infarction in perinatal and childhood bacterial meningitis
From the Departments of 1Pediatric Neurology, 2Neurology, 3Neurosurgery, 4Medicine, and 5Radiology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, and 6Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
Received 24 April 2003 and in revised form 30 July 2003
Background: Cerebral infarction is an important neurological complication of childhood bacterial meningitis, but little is known about its epidemiology and outcomes.
Aim: To determine the predictive factors, clinical features, causative pathogens, and outcomes of cerebral infarction secondary to perinatal and childhood bacterial meningitis.
Design: Retrospective analysis
Methods: Over the period 1986–2001, 166 perinatal and childhood patients were identified as having culture-proven bacterial meningitis, of whom 14 had cerebral infarction at admission. The clinical and CSF data of patients with and without cerebral infarctions on admission were compared.
Results: Cerebral infarction patients accounted for 10% (14/166) of bacterial meningitis cases, mostly in the first year of life (11/14, 79%). Salmonella species (n = 4) and Streptococcus pneumoniae (n = 4) were the most frequent causative pathogens, accounting for 57% (8/14) of episodes. Single infarctions were found in four patients and multiple infarctions in 10. At 1 year follow-up, outcome was good in three, but poor in 11. Significant differences between the two patient groups at admission included age bands, presence of seizures, hydrocephalus, disturbed consciousness on admission, and CSF lactate concentration.
Discussion: There was a high prevalence of cerebral infarctions when the disease was caused by S. pneumoniae and Salmonella species. Occurrence was highest in the first year of life, and the prognosis in this patient group is poor. Risk factors associated with cerebral infarction in our patients included age 28–365 days, seizures, hydrocephalus, disturbed consciousness on admission, and high CSF lactate concentrations.
Address correspondence to Dr C.-H. Lu, Department of Neurology, Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. e-mail: chlu99{at}ms44.url.com.tw