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Artiaga A, Herman F, Arquizan C, Thouvenot E, Loubet P, Le Moing V, Picot MC, Makinson A. Cerebral vasculitis as a complication of pneumococcal meningitis: A cohort study. Infect Dis Now 2023; 53:104772. [PMID: 37619963 DOI: 10.1016/j.idnow.2023.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Cerebral vasculitis (CV) is a severe complication of pneumococcal meningitis (PM); whether dexamethasone use can reduce its occurrence remains to be determined. METHODS This is a retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020 in two tertiary hospitals. Extrapolating from a standardized definition of primary angiitis of the central nervous system, we defined CV as worsened neurological symptoms associated with compatible imaging. All images were analyzed by a radiologist, and two neurologists reviewed all inconclusive cases of suspected CV for adjudication. Factors associated with CV were analyzed, including dexamethasone use. A subgroup analysis was limited to patients with a lumbar puncture at PM diagnosis. RESULTS Among 168 patients with PM, 49 (29.2%) had CV, occurring after a median of 8 days (IQR 5-13) of PM diagnosis. In multivariate analysis (N = 151), initial CRP was associated with CV (OR 1.28 per 50-unit increase, p = 0.003), which was marginally linked with delayed hospital admission more than 48 hours after first symptoms (OR 2.39, p = 0.06) and prior NSAID intake (OR 2.94, p = 0.05). Dexamethasone administration did not impact CV occurrence. In 133 patients having undergone lumbar puncture, CSF protein level > 4.4 g/L (OR 4.50, p = 0.006) was associated with CV. CONCLUSIONS In our cohort, CV was a frequent and severe complication of PM, often occurring in association with unduly delayed medical care, high CRP at admission, and high levels of protein in CSF.
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Affiliation(s)
- Agathe Artiaga
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France
| | - Fanchon Herman
- Medical Information Department - University Hospital of Montpellier, France
| | - Caroline Arquizan
- Stroke Unit, Department of Neurology, University of Montpellier, France; Paris Descartes University, INSERM 1226, Paris, France
| | - Eric Thouvenot
- Neurology Department - University Hospital of Nimes, France; Functional Genomics Institute, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department - University Hospital of Nimes, France; Inserm U1047 University of Montpellier Nimes, France
| | - Vincent Le Moing
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Medical Information Department - University Hospital of Montpellier, France; Clinical Research and Epidemiology Unit, INSERM, Clinical Investigation Centre 1411, University of Montpellier, France
| | - Alain Makinson
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France.
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Vandelli G, Giacobazzi L, Ciolli L, Dell’Acqua ML, Vandelli L, Picchetto L, Rosafio F, Borzì GM, Ricceri R, Meletti S, Vallone S, Salvarani C, Sebastiani M, Sacchetti F, Verganti L, Merolla S, Zelent G, Bigliardi G. Intracranial Stenosis Treated with Stenting in Patients with Suspected Cerebral Vasculitis: Two Case Reports. Case Rep Neurol 2023; 15:100-107. [PMID: 37476369 PMCID: PMC10355127 DOI: 10.1159/000529942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/03/2023] [Indexed: 07/22/2023] Open
Abstract
Central nervous system vasculitis (CNSV) is an uncommon and poorly understood form of vasculitis. Early recognition is important because medical treatment might improve the outcome. However, randomized clinical trials on CNSV treatment do not exist. Endovascular treatment has been reported in few cases, but no data exist for intracranial stenting. We report 2 cases of patients with suspected CNSV and recurrent clinical episodes, treated with intracranial stenting. A 48-year-old man had relapsing episodes of right hemiparesis. Neuroradiological exams showed severe left carotid terminus stenosis. Despite immunosuppressive therapy, neuroradiological follow-up exams showed a worsening of the aforementioned stenosis with many transient episodes of weakness in the right limbs and aphasia. A 64-year-old woman had a sudden onset of dysarthria and transient aphasia. Neuroradiological exams showed a severe arterial stenosis involving the origin of left anterior cerebral artery and middle cerebral artery (MCA). Despite dual antiplatelet therapy, she presented an acute onset of severe aphasia, due to an occlusion of the left carotid terminus and proximal MCA. In both cases, endovascular procedure and intracranial stenting was performed, with marked improvement of cerebral blood flow. No more clinical episodes were reported. Intracranial stenting may be a valid therapeutic option in selected patients with CNSV and involvement of medium or large size vessels with clinical worsening despite best medical treatment.
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Affiliation(s)
- Gabriele Vandelli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Giacobazzi
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ludovico Ciolli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Luisa Dell’Acqua
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Vandelli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Livio Picchetto
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Rosafio
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giuseppe Maria Borzì
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Riccardo Ricceri
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Meletti
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Vallone
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Modena, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federico Sacchetti
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Luca Verganti
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Merolla
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gabriele Zelent
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Guido Bigliardi
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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