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

Aims: We aimed at quantifying acute axonal injury ill 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 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 polls, followed by the hippocampal formation. neocortex and the cervical spinal cord. The cerebellum was least affected. Conclusion: Axonal injury is a frequent complication or bacterial meningitis probably contributing to long-term sequelae in survivours.