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Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score.

Lucas MJ, Brouwer MC, van der Ende A, van de Beek D - Neurol Neuroimmunol Neuroinflamm (2014)

Bottom Line: Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%).However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale.However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.

ABSTRACT

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown.

Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012.

Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died.

Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

No MeSH data available.


Related in: MedlinePlus

Spectrum of abnormal CT scanning of patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score(A) Generalized cerebral edema with signs of pseudo-subarachnoid hemorrhage; (B) subdural empyema; (C) generalized cerebral edema indicating severe cerebral inflammation; (D) hydrocephalus.
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Figure 2: Spectrum of abnormal CT scanning of patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score(A) Generalized cerebral edema with signs of pseudo-subarachnoid hemorrhage; (B) subdural empyema; (C) generalized cerebral edema indicating severe cerebral inflammation; (D) hydrocephalus.

Mentions: Cranial CT on admission was performed in 27 of 30 patients (90%) and was abnormal in 67% (table 1; figure 2). In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained either by complications resulting from the meningitis (seizures in 10, hydrocephalus in 5, and cerebral edema in 7) or by sedative medication (5 patients). In the other 8 patients, the minimal score on the Glasgow Coma Scale was explained by a direct effect of the meningitis (defined as a combination of severe brain inflammation and raised ICP).


Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score.

Lucas MJ, Brouwer MC, van der Ende A, van de Beek D - Neurol Neuroimmunol Neuroinflamm (2014)

Spectrum of abnormal CT scanning of patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score(A) Generalized cerebral edema with signs of pseudo-subarachnoid hemorrhage; (B) subdural empyema; (C) generalized cerebral edema indicating severe cerebral inflammation; (D) hydrocephalus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4202677&req=5

Figure 2: Spectrum of abnormal CT scanning of patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score(A) Generalized cerebral edema with signs of pseudo-subarachnoid hemorrhage; (B) subdural empyema; (C) generalized cerebral edema indicating severe cerebral inflammation; (D) hydrocephalus.
Mentions: Cranial CT on admission was performed in 27 of 30 patients (90%) and was abnormal in 67% (table 1; figure 2). In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained either by complications resulting from the meningitis (seizures in 10, hydrocephalus in 5, and cerebral edema in 7) or by sedative medication (5 patients). In the other 8 patients, the minimal score on the Glasgow Coma Scale was explained by a direct effect of the meningitis (defined as a combination of severe brain inflammation and raised ICP).

Bottom Line: Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%).However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale.However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.

ABSTRACT

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown.

Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012.

Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died.

Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

No MeSH data available.


Related in: MedlinePlus