Presumed Cerebral Vasculitis Following Pneumococcal Meningitis: A Rare but Life-Threatening Complication.

A 65-year-old woman presented with pneumococcal sepsis and meningitis. Despite appropriate antimicrobial therapy and intravenous (IV) dexamethasone, her mental status did not improve. Findings of brain imaging were suggestive of cerebral vasculitis. Her condition improved rapidly with the initiation of high-dose IV methylprednisolone therapy. One week after completion of a 3-week oral prednisone taper, the patient's neurocognitive deficits recurred. A more extensive diagnostic evaluation, including conventional angiography, was again consistent with a presumptive diagnosis of cerebral vasculitis. High-dose IV methylprednisolone and a more prolonged taper of oral prednisone led to remission of her disease, with marked improvement in mental status and left-sided hemiparesis. Cerebral vasculitis is a rare but potentially lethal complication of pneumococcal meningitis that may be difficult to recognize and treat. The role of brain biopsy in diagnosis is unclear, and due to its rarity, management of this condition lacks conclusive evidence-based data.