{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:38:53Z","timestamp":1789925933369,"version":"4.0.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":1838,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute of Public Health and the Environment"},{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["916.13.078"],"award-info":[{"award-number":["916.13.078"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["91819627"],"award-info":[{"award-number":["91819627"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Public Health and the Environment"},{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["916.13.078"],"award-info":[{"award-number":["916.13.078"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["91819627"],"award-info":[{"award-number":["91819627"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Community-acquired bacterial meningitis may be complicated by cerebral venous thrombosis (CVT), but this has not systematically been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated clinical characteristics and outcome of CVT in adults with community-acquired bacterial meningitis in a prospective nationwide cohort study of bacterial meningitis (2006\u20132018) in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CVT occurred in 26 of 2220 episodes with bacterial meningitis (1%). The diagnosis of CVT was made on the day of presentation in 15 patients (58%) and during hospital stay in 11 patients after a median of 6\u2009days (IQR 2\u20137). Sinusitis or otitis was present in 16 of 24 patients (67%). Patients with CVT presented more often in a coma than those without CVT (53 vs. 18%; P\u2009=\u20090.001) and the clinical course was more often complicated by focal neurologic deficits (58 vs. 22%; P\u2009&amp;lt;\u20090.001). Twelve patients of 26 (46%) had parenchymal lesions on neuroimaging, of whom two (8%) were specific for CVT. The transverse sinus was most frequently thrombosed (18 of 26; 69%). Streptococcus pneumoniae was the most common causative pathogen, occurring in 17 of 26 patients (65%). Eleven patients (44%) received anticoagulant therapy with heparin and none of them developed intracerebral hemorrhage during admission. Unfavorable outcome, as defined as a score on the Glasgow Outcome Scale &amp;lt;5, occurred in 14 of 26 patients (54%) and 4 patients (15%) died.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion<\/jats:title>\n                    <jats:p>CVT is a rare complication of bacterial meningitis and mainly occurs in patients with coma, ear, nose and throat infections, and focal neurologic deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2396987320971112","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T02:14:58Z","timestamp":1605147298000},"page":"394-401","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":30,"title":["Bacterial meningitis complicated by cerebral venous thrombosis"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6402-6598","authenticated-orcid":false,"given":"Shahrzad S","family":"Deliran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs C","family":"Brouwer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-982X","authenticated-orcid":false,"given":"Jonathan M","family":"Coutinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik van de","family":"Beek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"2026012113164506600_bibr1-2396987320971112","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1056\/NEJMoa040845","article-title":"Clinical features and prognostic factors in adults with bacterial meningitis","volume":"351","author":"van de Beek","year":"2004","journal-title":"N Engl J Med"},{"key":"2026012113164506600_bibr2-2396987320971112","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S1473-3099(15)00430-2","article-title":"Community-acquired bacterial meningitis in adults in The Netherlands, 2006-14: a prospective cohort study","volume":"16","author":"Bijlsma","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2026012113164506600_bibr3-2396987320971112","doi-asserted-by":"crossref","DOI":"10.1038\/nrdp.2016.74","article-title":"Community-acquired bacterial meningitis","volume":"2","author":"van de Beek","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2026012113164506600_bibr4-2396987320971112","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1212\/WNL.0b013e3181f11e10","article-title":"Hydrocephalus in adults with community-acquired bacterial meningitis","volume":"75","author":"Kasanmoentalib","year":"2010","journal-title":"Neurology"},{"key":"2026012113164506600_bibr5-2396987320971112","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1212\/01.wnl.0000288178.91614.5d","article-title":"Seizures in adults with bacterial meningitis","volume":"70","author":"Zoons","year":"2008","journal-title":"Neurology"},{"key":"2026012113164506600_bibr6-2396987320971112","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s12028-011-9634-4","article-title":"Cerebral infarction in adults with bacterial meningitis","volume":"16","author":"Schut","year":"2012","journal-title":"Neurocrit Care"},{"key":"2026012113164506600_bibr7-2396987320971112","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jinf.2016.04.009","article-title":"Neurological sequelae of bacterial meningitis","volume":"73","author":"Lucas","year":"2016","journal-title":"J Infect"},{"key":"2026012113164506600_bibr8-2396987320971112","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1056\/NEJMra052116","article-title":"Community-acquired bacterial meningitis in adults","volume":"354","author":"van de Beek","year":"2006","journal-title":"N Engl J Med"},{"key":"2026012113164506600_bibr9-2396987320971112","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1093\/brain\/awg113","article-title":"Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases","volume":"126","author":"Kastenbauer","year":"2003","journal-title":"Brain"},{"key":"2026012113164506600_bibr10-2396987320971112","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S1474-4422(05)70288-X","article-title":"Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series","volume":"5","author":"Weisfelt","year":"2006","journal-title":"Lancet Neurol"},{"key":"2026012113164506600_bibr11-2396987320971112","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1212\/WNL.42.8.1497","article-title":"Cerebrovascular complications of bacterial meningitis in adults","volume":"42","author":"Pfister","year":"1992","journal-title":"Neurology"},{"key":"2026012113164506600_bibr12-2396987320971112","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1001\/archneur.1993.00540060015010","article-title":"Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study","volume":"50","author":"Pfister","year":"1993","journal-title":"Arch Neurol"},{"key":"2026012113164506600_bibr13-2396987320971112","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/1471-2431-14-147","article-title":"Multiple cerebral sinus thromboses complicating meningococcal meningitis: a pediatric case report","volume":"14","author":"Bozzola","year":"2014","journal-title":"BMC Pediatr"},{"key":"2026012113164506600_bibr14-2396987320971112","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ejpn.2007.06.007","article-title":"Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions","volume":"12","author":"Jorens","year":"2008","journal-title":"Eur J Paediatr Neurol"},{"key":"2026012113164506600_bibr15-2396987320971112","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1177\/197140090802100305","article-title":"Klebsiella meningitis. A case report","volume":"21","author":"Medhi","year":"2008","journal-title":"Neuroradiol J"},{"key":"2026012113164506600_bibr16-2396987320971112","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1177\/1971400915589688","article-title":"Cerebral sinovenous thrombosis in a child with Crohn's disease, otitis media, and meningitis","volume":"28","author":"Selvitop","year":"2015","journal-title":"Neuroradiol J"},{"key":"2026012113164506600_bibr17-2396987320971112","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.jemermed.2014.09.008","article-title":"Cerebral venous sinus thrombophlebitis as a complication of acute otitis media","volume":"48","author":"Sharma","year":"2015","journal-title":"J Emerg Med"},{"key":"2026012113164506600_bibr18-2396987320971112","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ijid.2018.04.005","article-title":"Streptococcus gallolyticus subsp. pasteurianus meningitis complicated by venous sinus thrombosis: a case report","volume":"71","author":"Wardle","year":"2018","journal-title":"Int J Infect Dis"},{"key":"2026012113164506600_bibr19-2396987320971112","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJM200108093450604","article-title":"Cerebral sinovenous thrombosis in children","volume":"345","author":"deVeber","year":"2001","journal-title":"N Engl J Med"},{"key":"2026012113164506600_bibr20-2396987320971112","doi-asserted-by":"crossref","DOI":"10.1186\/s40478-016-0297-4","article-title":"Pneumococcal meningitis: clinical-pathological correlations (MeninGene-Path)","volume":"4","author":"Engelen-Lee","year":"2016","journal-title":"Acta Neuropathol Commun"},{"key":"2026012113164506600_bibr21-2396987320971112","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1212\/01.CON.0000446105.67173.a8","article-title":"Evaluation and management of cerebral venous thrombosis","volume":"20","author":"Bushnell","year":"2014","journal-title":"Continuum (Minneap Minn)"},{"key":"2026012113164506600_bibr22-2396987320971112","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1161\/01.STR.0000177894.05495.54","article-title":"Cerebral vein and dural sinus thrombosis in elderly patients","volume":"36","author":"Ferro","year":"2005","journal-title":"Stroke"},{"key":"2026012113164506600_bibr23-2396987320971112","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1161\/01.STR.0000117571.76197.26","article-title":"Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT)","volume":"35","author":"Ferro","year":"2004","journal-title":"Stroke"},{"key":"2026012113164506600_bibr24-2396987320971112","first-page":"CD002005","article-title":"Anticoagulation for cerebral venous sinus thrombosis","author":"Coutinho","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2026012113164506600_bibr25-2396987320971112","doi-asserted-by":"crossref","first-page":"e45271","DOI":"10.1371\/journal.pone.0045271","article-title":"Intracerebral hemorrhages in adults with community associated bacterial meningitis in adults: should we reconsider anticoagulant therapy?","volume":"7","author":"Mook-Kanamori","year":"2012","journal-title":"PLoS One"},{"key":"2026012113164506600_bibr26-2396987320971112","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1161\/STR.0b013e31820a8364","article-title":"Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American heart association\/American stroke association","volume":"42","author":"Saposnik","year":"2011","journal-title":"Stroke"},{"key":"2026012113164506600_bibr27-2396987320971112","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1111\/j.1468-1331.2010.03011.x","article-title":"EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients","volume":"17","author":"Einhaupl","year":"2010","journal-title":"Eur J Neurol"},{"key":"2026012113164506600_bibr28-2396987320971112","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1001\/jama.1989.03430190084036","article-title":"Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations","volume":"262","author":"Spanos","year":"1989","journal-title":"Jama"},{"key":"2026012113164506600_bibr29-2396987320971112","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/S0140-6736(76)92215-7","article-title":"Predicting outcome in individual patients after severe head injury","volume":"1","author":"Jennett","year":"1976","journal-title":"Lancet"},{"key":"2026012113164506600_bibr30-2396987320971112","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.cmi.2016.01.007","article-title":"ESCMID guideline: diagnosis and treatment of acute bacterial meningitis","volume":"22 Suppl 3","author":"van de Beek","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"2026012113164506600_bibr31-2396987320971112","first-page":"CD004405","article-title":"Corticosteroids for acute bacterial meningitis","author":"Brouwer","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2026012113164506600_bibr32-2396987320971112","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1212\/WNL.0b013e3181f96297","article-title":"Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis","volume":"75","author":"Brouwer","year":"2010","journal-title":"Neurology"},{"key":"2026012113164506600_bibr33-2396987320971112","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s00381-008-0665-x","article-title":"Subdural empyema secondary to sinus infection in children","volume":"25","author":"Osman Farah","year":"2009","journal-title":"Childs Nerv Syst"},{"key":"2026012113164506600_bibr34-2396987320971112","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/MAO.0000000000002138","article-title":"Risk factors associated with mortality in patients with otogenic brain abscess","volume":"40","author":"Burton","year":"2019","journal-title":"Otol Neurotol"},{"key":"2026012113164506600_bibr35-2396987320971112","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1288\/00005537-198308000-00010","article-title":"Intracranial complications of acute and chronic infectious ear disease: a problem still with us","volume":"93","author":"Gower","year":"1983","journal-title":"Laryngoscope"},{"key":"2026012113164506600_bibr36-2396987320971112","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S0196-0709(98)90083-7","article-title":"Acute mastoiditis: a 10-year review","volume":"19","author":"Khafif","year":"1998","journal-title":"Am J Otolaryngol"},{"key":"2026012113164506600_bibr37-2396987320971112","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/BF01716698","article-title":"Acute mastoiditis\u2013relevant once again","volume":"22","author":"Hoppe","year":"1994","journal-title":"Infection"},{"key":"2026012113164506600_bibr38-2396987320971112","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.ijporl.2005.12.002","article-title":"Indications for surgery in acute mastoiditis and their complications in children","volume":"70","author":"Zanetti","year":"2006","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"2026012113164506600_bibr39-2396987320971112","first-page":"20","article-title":"Acute bacterial meningitis caused by acute otitis media in adults: a series of 12 patients","volume":"96","author":"Kaplan","year":"2017","journal-title":"Ear Nose Throat J"},{"key":"2026012113164506600_bibr40-2396987320971112","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1161\/STROKEAHA.115.011875","article-title":"Clinical outcome of anticoagulant treatment in head or neck infection-associated cerebral venous thrombosis","volume":"47","author":"Zuurbier","year":"2016","journal-title":"Stroke"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2396987320971112","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2396987320971112","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/5\/4\/394\/64646941\/2396987320971112.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/5\/4\/394\/64646941\/2396987320971112.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:18:50Z","timestamp":1769019530000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/5\/4\/394\/8271506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1177\/2396987320971112","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12,1]]},"published":{"date-parts":[[2020,12,1]]}}}