Septic Cortical Thrombophlebitis

Thrombosis of cortical veins has been postulated as an important cause of seizures and focal neurologic deficits in patients with bacterial meningitis. Diagnoses from autopsies, angiograms, and medical records at Massachusetts General Hospital, 1960-1984, were reviewed to identify patients with septic cortical thrombophlebitis. Only 10 confirmed cases of septic cortical vein thrombosis without sagittal sinus thrombosis were found. Meningitis was present in nine patients; Streptococcus pneumoniae was isolated from the blood or cerebrospinal fluid of five patients. Common clinical manifestations included fever, seizures, and focal neurologic signs. Half the patients survived, but three had persistent disabilities. Cortical vein thrombosis could be documented in only ^19o of 790 cases of bacterial meningitis. In 97 patients with meningitis who died and had autopsies, cortical thrombophlebitis was identified in 5%. In autopsied patients, other pathologic processes including arteritis, ventriculitis, cavernous sinus thrombosis, and cerebral infarctions were usually more prominent than venous thrombosis. Cortical thrombophlebitis does not appear to be the major cause of seizures or focal neurologic signs during bacterial meningitis.