Introduction:

Cerebrovascular complications associated with pneumococcal meningitis are linked to a worse prognosis and occur relatively frequently.

Case reports:

We present two patients with pneumococcal meningitis who developed vascular complications during their course, with different clinical phenotypes. The first patient progressed to severe neurological deterioration due to multiple cerebral infarcts in supra- and infratentorial regions, without clinical improvement. The second patient presented with subdural hematomas and subarachnoid hemorrhage with severe neurological deterioration, which improved significantly after treatment with methylprednisolone.

Conclusions:

The presented cases reflect the severity of cerebrovascular complications of pneumococcal meningitis. Its clinical presentation is heterogeneous and nonspecific; therefore, it must be confirmed with imaging studies. Although there is no proven specific treatment, some authors suggest the use of corticosteroids.

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