Features of bacterial meningitis
Pathogenesis, common clinical findings, diagnostic approach, neuroimaging findings, and complications of bacterial meningitis.
|Pathogenesis||Bacteria enter subarachnoid space → replication and autolysis → release of bacterial components in CSF → release of proinflammatory host factors|
|Clinical findings||Stiff neck, headache, fever, photophobia, malaise, vomiting, lethargy → deterioration of level of consciousness|
|Diagnosis||Lumbar puncture: elevated opening pressure, polymorphonuclear leukocytic pleocytosis, elevated protein, low glucose, and elevated lactate in postneurosurgical patients, gram-stained smear, CSF culture|
Blood cultures, CRP/ESR
|CT/MRI findings||Cerebral edema, hydrocephalus, ventriculitis, vasculitis, septic embolism, sinus venous thrombus causing infarction, intracranial free air due to dural leak|
|Complications||Death with highest mortality in pneumococcal and Listeria meningitis|
Sensorineural hearing loss
Hemiparesis, epileptic seizures, hemianopia, ataxia, cranial nerve palsies
CSF , Cerebrospinal fluid; CRP , C-reactive protein; ESR , sedimentation rate.
Data from Roos KL: Meningitis: 100 Maxims. London, Arnold, 1996