A patient recovering from acute bacterial meningitis may deteriorate following delayed cerebral thrombosis. One hypothesis is an antibody response to residual bacterial capsular antigens.
Patient selection: status post acute bacterial meningitis
Clinical features:
(1) sudden deterioration 7 to 21 days after apparent recovery from acute bacterial meningitis
(2) headache
(3) fever
(4) decreased level of consciousness
(5) brainstem signs or hemiparesis
(6) seizures
(7) cerebral infarcts identified in imaging studies
(8) exclusion of other explanation (atrial fibrillation, endocarditis, vasculitis, etc)
Risk factors:
(1) Streptococcus pneumoniae as cause of the meningitis
(2) dexamethasone therapy for the meningitis
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