Deliran Shahrzad S, Brouwer Matthijs C, van de Beek Diederik
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands,
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
Cerebrovasc Dis. 2022;51(1):118-124. doi: 10.1159/000518089. Epub 2021 Aug 24.
Subarachnoid hemorrhage (SAH) has been described as an uncommon complication of community-acquired bacterial meningitis. However, the incidence, clinical course, and outcome are unclear.
We assessed the clinical characteristics, incidence, and clinical outcome of patients with SAH complicating bacterial meningitis in a prospective nationwide cohort study from 2006 to 2018 in the Netherlands. Patients were identified through the Netherlands Reference Laboratory for Bacterial Meningitis, which receives around 90% of CSF isolates of all Dutch patients with bacterial meningitis, or after direct report by the treating physician.
SAH was diagnosed in 22 of 2,306 episodes (0.9%), of which 7 (32%) were diagnosed upon admission and 15 (68%) during admission. All patients showed clinical deterioration before SAH was diagnosed: altered mental status in 18 of 22 patients (82%), focal neurological symptoms in 2 (9%) and, new-onset fever with severe tachycardia in 1 (5%). Acute onset of headache was not reported in any of the patients. Distribution of blood was diffuse in the subarachnoid space in 7 patients (32%), multifocal in 8 patients (36%), and focal in 7 patients (32%) of 22 patients. In 6 patients (27%), CT angiography, MR angiography, or digital subtraction angiography was performed, showing a mycotic aneurysm in 1 patient (5%) and vasculitis in 1 patient (5%). Presence of SAH in bacterial meningitis patients was associated with a poor prognosis assessed at discharge: 12 of 22 patients with SAH died (54%) compared to 361 of 2,257 (16%, p < 0.001) without SAH, and 19 of 22 had an unfavorable outcome (86%) compared to 831 of 2,257 (37%, p < 0.001).
SAH is an uncommon complication in bacterial meningitis and is associated with high case fatality and morbidity.
蛛网膜下腔出血（SAH）被描述为社区获得性细菌性脑膜炎的一种罕见并发症。然而，其发病率、临床病程及预后尚不清楚。
在荷兰2006年至2018年的一项全国性前瞻性队列研究中，我们评估了合并细菌性脑膜炎的SAH患者的临床特征、发病率及临床结局。患者通过荷兰细菌性脑膜炎参考实验室识别，该实验室接收了荷兰所有细菌性脑膜炎患者约90%的脑脊液分离株，或由治疗医师直接报告。
在2306例病例中有22例（0.9%）诊断为SAH，其中7例（32%）在入院时诊断，15例（68%）在住院期间诊断。所有患者在SAH诊断前均出现临床恶化：22例患者中有18例（82%）精神状态改变，2例（9%）有局灶性神经症状，1例（5%）新发发热伴严重心动过速。所有患者均未报告头痛急性发作。22例患者中，7例（32%）蛛网膜下腔内血液分布弥漫，8例（36%）为多灶性，7例（32%）为局灶性。6例（27%）患者进行了CT血管造影、磁共振血管造影或数字减影血管造影，1例（5%）显示霉菌性动脉瘤，1例（5%）显示血管炎。细菌性脑膜炎患者合并SAH与出院时评估的不良预后相关：22例合并SAH的患者中有12例死亡（54%），而2257例无SAH的患者中有361例死亡（16%，p<0.001）；22例中有19例预后不良（86%），而2257例中831例预后不良（37%，p<0.001）。
SAH是细菌性脑膜炎的一种罕见并发症，与高病死率和高发病率相关。
