Localization of cerebral vasculopathy following bacterial meningitis: What can we learn about postinfective ischemic sequelae?

Abstract

Cerebrovascular complications of bacterial meningitis account for a high incidence of mortality and postinfective neurologic sequelae. Cerebrovascular complications occurring during acute bacterial meningitis are evident from angiographic evidence demonstrating arterial occlusion and vessel wall narrowing, histopathological studies demonstrating vessel wall changes, and radiographic studies demonstrating the presence of brain infarcts. Cerebrovascular disease during bacterial meningitis has been demonstrated in of Haemophilus influenzae, Streptococcus pneumonia, Group B Streptococcus, and Mycobacterium tuberculosis models of meningitis. Despite models of bacterial meningitis showing variable patterns of cerebral vasculopathy as a contributor to different aspects of postinfectious neurological decline, very few studies describe the predominant localization of cerebral vasculopathy with different meningitis causing pathogens. Thus, this review attempts to analyze the different locations of cerebral vasculopathic changes occuring in response to different microbial pathogens and provide a pathophysiologic basis for such an observation.

Keywords: Bacterial Meningitis; Group B Streptococcus; Haemophilus influenza; Mycobacterium tuberculosis; Streptococcus pneumonia; Vasculopathy.

Figure 1

Areas of cerebrovascular stenosis (blue) in different models of bacterial meningitis. In Hemophilus influenzae meningitis, the internal carotid artery and its cranial regions, particularly the supraclinoid portion, are affected. (A) Conversely, during Streptococcus pneumonia or Group B Streptococcal meningitis, the middle cerebral artery and its penetrating intracerebral branches are involved. (B) Finally, In Mycobacterium tuberculosis meningitis, the basilar artery and other arteries at the base of the brain are affected[67].

Figure 2

Preferential sites of cerebral vessel involvement in Streptococcus pneumonia/Group B streptococcus meningitis[67] A: Frontal Cortex, B: Temporal Cortex, C: Frontal Cortex, D: Occipital Cortex; E: Thalamus; F: Basal Ganglia

Figure 3

Distribution of dense purulent exudate over the cerebral convexities in Group B Streptococci/Streptococcus pneumococci meningitis[67]

Figure 4

Distribution of very dense purulent exudate over the base of the brain in Mycobacterium tuberculosis meningitis[67]

Figure 5

Preferential sites of cerebral vessel involvement in Mycobacterium tuberculosis meningitis.[67] A: Cerebral Cortex, B: Thalamus, C: Pons, D: Cerebellum, E: Basal Ganglia