A multidisciplinary approach to the treatment of severe cerebral vasospasm following bacterial meningitis: A case report and literature review

BACKGROUND: Although cerebrovascular complications of bacterial meningitis are common, postmeningitic cerebral vasospasm significant enough to result in ischemic injury has been reported in only limited fashion. CASE DESCRIPTION: We describe a case of severe cerebral vasospasm following streptococcal meningitis managed successfully with emergency suboccipital decompression, extracranial-intracranial bypass, intra-arterial vasodilator infusion, and maximal medical therapy. To our knowledge, this may be the first case in which surgical cerebral revascularization has been utilized to limit ischemic injury in the setting of postmeningitic cerebral vasospasm. CONCLUSIONS: Patients presenting with abrupt neurological decline following recent treatment for bacterial meningitis may be suffering from a reversible vasoconstriction of the cerebral arteries, and prompt aggressive treatment can result in a favorable outcome even in patients who present in very poor neurological condition.