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Evidence for frequent focal and diffuse acute axonal injury in human bacterial meningitis.

AIMS
We aimed at quantifying acute axonal injury in victims of bacterial meningitis.


METHODS
The brains of 26 autopsies with bacterial meningitis and of 10 control cases were studied by histology and quantitative immunohistochemistry for amyloid-beta precursor protein (APP).


RESULTS
Mild to severe axonal injury in the white matter was present in 25 of 26 victims of meningitis. The area of axonal damage ranged from 0.0% to 1.38% (median = 0.08%, mean = 0.36%) of the total area studied in each individual case. In 4 of 10 age- and sex-matched control brains small areas also stained for APP (p = 0.0007). Axonal injury in meningitis was most prominent in the basal ganglia and pons, followed by the hippocampal formation, neocortex and the cervical spinal cord. The cerebellum was least affected.


CONCLUSION
Axonal injury is a frequent complication of bacterial meningitis probably contributing to long-term sequelae in survivors.