# Delayed cerebral vasculopathy following pneumococcal meningitis: a case report

## TL;DR

A 66-year-old man developed delayed cerebral vasculopathy after pneumococcal meningitis, leading to multiple strokes and treated with Milrinone.

## Contribution

This case report highlights DCV as a rare complication of ABM without dexamethasone use and successful treatment with Milrinone.

## Key findings

- The patient experienced repeated acute infarcts due to delayed cerebral vasculopathy following ABM.
- Multifocal vascular stenosis consistent with vasospasm was successfully treated with Milrinone.
- Dexamethasone was not administered due to meningitis diagnosis after antibiotic initiation.

## Abstract

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.