Stroke in Patients with Bacterial Meningitis: A Cohort Study and Meta-Analysis

被引:7
作者
Beuker, Carolin [1 ,2 ]
Werring, Nils [2 ]
Bonberg, Nadine [3 ]
Strecker, Jan-Kolja [2 ]
Schmidt-Pogoda, Antje [2 ]
Schwindt, Wolfram [3 ]
Stracke, Paul [4 ]
Schulte-Mecklenbeck, Andreas [2 ]
Gross, Catharina [2 ]
Wiendl, Heinz [2 ]
Minnerup, Heike [3 ]
Minnerup, Jens [2 ]
机构
[1] Albert Schweitzer Campus 1, D-48149 Munster, Germany
[2] Univ Munster, Dept Neurol, Inst Translat Neurol, Munster, Germany
[3] Univ Munster, Inst Epidemiol & Social Med, Munster, Germany
[4] Univ Hosp Muenster, Dept Clin Radiol, Munster, Germany
关键词
DELAYED CEREBRAL THROMBOSIS; PNEUMOCOCCAL MENINGITIS; ADULTS; COMPLICATIONS; SPECTRUM;
D O I
10.1002/ana.26618
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: The purpose of this study was to characterize patients with ischemic stroke due to bacterial meningitis.Methods: In a single-center retrospective study, we analyzed 102 patients with bacterial meningitis of which 19 had an ischemic stroke. Clinical characteristics, cerebrospinal fluid (CSF) analyses, and spatiotemporal distribution of infarcts were assessed. In addition, we searched PubMed from database inception to August 2021 for observational studies on ischemic stroke in patients with bacterial meningitis, and performed a meta-analysis to investigate the frequency and timing of stroke as well as its effect on mortality.Results: In our cohort, 15 (78.9%) patients with stroke had an modified Rankin scale (mRS) >= 3 at discharge compared to 33 (39.8%) in patients without stroke (p < 0.01). Of 1,692 patients with bacterial meningitis from 15 cohort studies included in our meta-analysis, cerebral infarcts were found in 332 (16%, 95% confidence interval [CI] = 0.13-0.20) patients. The occurrence of stroke was strongly associated with a higher mortality (odds ratio [OR] = 2.38, 95% CI = 1.70-3.34, p < 0.0001). There was no association of any specific causative pathogen with the occurrence of stroke. Infarcts were mainly distributed in territories of arteries located in the vicinity to the infection focus and peaked at 3 to -7 days and at 2 weeks after onset of meningitis. In patients with ischemic stroke, vasculopathy was found in 63.2% and additional intracerebral hemorrhage in 15.8%.Interpretation: This study found that ischemic stroke due to bacterial meningitis is caused by cerebral vasculopathy located in the vicinity of the infection focus, and that the time course of infarctions might enable a therapeutic intervention.
引用
收藏
页码:1094 / 1105
页数:12
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