Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Ischemic changes and blood coagulation abnormalities as complications of pneumococcal meningitis

Takashi Sugiyama, M.D.1)3), Tsuyoshi Uchiyama, M.D.1), Hirotsugu Takashima, M.D.1), Daisuke Yamamoto, M.D.1), Keishiro Sato, M.D.1), Takako Shimizu, M.D.1), Yoshiro Otsuki, M.D.2) and Toshihiko Ohashi, M.D.1)

1)Department of Neurology, Seirei Hamamatsu General Hospital
2)Department of Pathology, Seirei Hamamatsu General Hospital
3)Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki

One explanation for cerebral infarctions that occur as a complication of pneumococcal meningitis is blood coagulation abnormalities. We investigated the clinical features, laboratory test results, magnetic resonance imaging (MRI) findings, and pathological features of 10 patients with pneumococcal meningitis between 2006 and 2013 to examine the abnormal findings that may be associated with prognosis. Five patients (50%) that had Glasgow Outcome Scale scores between 1 and 4 were classified as the poor outcome group. In this group, the MRI revealed a high signal intensity on the diffusionweighted image (DWI), and there was an abnormal signal along the cerebral cortex and Virchow-Robin spaces, which were characterized pathologically by ischemic changes. The plasma thrombin-antithrombin complex (TAT) levels showed greater differences between the poor and good prognosis groups than platlet and D-dimer levels; this suggested that high plasma TAT levels indicate a poor prognosis.
Full Text of this Article in Japanese PDF (1341K)

(CLINICA NEUROL, 55: 889|896, 2015)
key words: bacterial meningitis, Streptococcus pneumoniae, thrombin-antithrombin complex, diffusion-weighted image, cerebral infarction

(Received: 7-Apr-15)