Neonatal Arterial Ischemic Stroke and Sinovenous Thrombosis Associated With Meningitis

Abstract

This series describes 5 neonates with meningitis associated with arterial ischemic stroke or cerebral sinovenous thrombosis identified from a tertiary children's hospital perinatal stroke database. A retrospective chart review was performed to collect data on clinical presentations, type of meningitis, radiographic and electroencephalographic findings, neonatal intensive care unit course and complications, additional risk factors associated with stroke, and outcomes. The proportion of arterial ischemic stroke and sinovenous thrombosis in the database associated with meningitis was calculated. Neonates came to medical attention because of seizures (2), hydrocephalus (1), and behavior changes (2). The median age of presentation was birth (range, 0—18 days). Meningitis was bacterial in 4 and viral in 1. The median time from symptom onset to identification of the causative organisms of meningitis was 16.8 days (range, 13—23 days) and from symptom onset to diagnosis of stroke was 11 days (range, 4—18 days). One child had arterial ischemic stroke. Four had cerebral sinovenous thrombosis. One child died in the neonatal intensive care unit. Outcome data were available for 3 of the 4 surviving children; all had some degree of neurological deficit. All 5 of the neonates described had risk factors for perinatal thrombosis or embolization in addition to meningitis. Meningitis is associated with 1.6% (1/63) of cases of arterial ischemic stroke and 7.7% (4/52) of cases of cerebral sinovenous thrombosis in our perinatal stroke database. Further work is needed to clarify when infarction occurs during meningitis and which children are at highest risk.