Résumé
Despite implementation of adjunctive dexamethasone since 2008, morbidity and mortality of pneumococcal meningitis (PM) remain high. Cerebral vasculitis (CV) is a severe complication of PM, but data on its frequency and risk factors are scarce. Methods: retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020. CV was defined by a worsening of clinical symptoms and compatible radiological findings. Factors associated with CV were analyzed. A subgroup analysis only included patients with a lumbar puncture at initial diagnosis of PM. Results: 168 PM were analyzed, and 49 (29.2%) CV were identified. CV occurred after a median of 8 days (IQR 5 - 13) of PM diagnosis. In univariate analysis, prior NSAID use (OR 3.54, p < 0.01), symptoms for more than 48 hours (OR 2.72, p = 0.02) and CRP (OR 1.26 per 50 units, p 4.4 g/L (OR 4.50, p = 0.006) was also associated with CV. Conclusion: CV is a frequent complication of PM, increasingly occurring with delayed medical care and high CRP at admission. Adjunctive dexamethasone did not appear to reduce its frequency.