Delayed cerebral vasculopathy following pneumococcal meningitis: a case report

Acute bacterial meningitis (ABM) remains a common disease, especially in developing countries. Although morbidity and mortality have improved with advances in medicine, significant neurologic complications of meningitis still occur. Delayed cerebral vasculopathy (DCV) is a unique complication following ABM leading to ischemic strokes and poor functional outcomes. We describe a case of a 66-year-old man with repeated acute infarcts from DCV due to ABM, notably in the absence of empiric dexamethasone treatment, which was not administered as meningitis was diagnosed post-antibiotic initiation. New areas of acute ischemia were noted on repeat imaging on days 6, 24, and 30 of admission. Vascular imaging revealed multifocal vascular stenosis, consistent with vasospasm that was successfully treated with Milrinone.