PP04.6 – 2257: Arterial ischemic stroke in children with infectious meningitis

Objective Arterial ischemic stroke (AIS) is a serious complication of infectious meningitis, often conveying a poor outcome. We aim to identify children with infectious meningitis who are at risk of developing AIS. Methods We retrospectively studied inpatient children aged 1 month to 16 years with infectious meningitis at KK Women and Children's Hospital from 2008 to 2013. Infectious meningitis was defined as febrile encephalopathy with neurological signs and symptoms (including seizures, headache or meningism) and either a 1) positive cerebrospinal fluid (CSF) culture, 2) CSF pleocytosis or 3) subdural effusion, empyema or intracranial abscess. Children with immune-mediated encephalitis, eosinophilic meningitis and pre-existing risk factors for stroke were excluded. Results 97 patients were eligible but 17 were excluded as they had either cranial ultrasound or no neuroimaging. 17 had arterial ischemic strokes (21%). Streptococcus was isolated in 9 (7 S. pneumoniae and 2 S. milleri) children, of which 3 had received at least 1 dose of pneumococcal vaccination. Two children had enteroviral infection, one of whom had an Escherichia coli co-infection. Four children had tuberculous meningitis. Seizures, of which 78% were status epilepticus, (OR 7.50, 95% CI: 1.61–34.9) and severe hypoglycoracchia Conclusion AIS occurred in one-fifth of children with infectious meningitis, and Streptococcus was the commonest pathogen. Status epilepticus and severe hypoglycoracchia were likely representative of a severe infection at risk of AIS. Neuroimaging and aggressive antimicrobial therapy may be warranted in these children.