Pneumococcal meningitis complicated by cerebral venous thrombosis, intraparenchymal hematoma, and delayed cerebral vasculopathy: A case report

Case presentation: A 59-year-old woman with Parkinson disease developed pneumococcal meningoencephalitis complicated by thrombosis of both sigmoid sinuses and the right transverse (lateral) sinus, followed 10 days later by a right frontal intraparenchymal hematoma with intraventricular extension and acute tetraventricular hydrocephalus requiring surgical evacuation and external ventricular drainage.
Discussion: Subsequent neuroimaging showed persistent hydrocephalus, multiple hemorrhagic lesions, diffuse cerebral edema, brain herniation, bilateral cerebellar ischemic lesions, and focal arterial stenoses suggestive of associated inflammatory cerebral vasculopathy. This case highlights the severe venous–hemorrhagic–arterial continuum that may complicate pneumococcal meningitis and underscores the therapeutic uncertainty surrounding anticoagulation in septic cerebral venous thrombosis.
Conclusion: Repeated multimodal neuroimaging, early neurosurgical assessment, and aggressive neurocritical care are crucial, although prognosis remains poor once intraparenchymal hematoma, hydrocephalus, and herniation syndromes have developed.