Hydrocephalus in adults with community-acquired bacterial meningitis

Abstract

Objective: To evaluate the occurrence, treatment, and outcome of hydrocephalus complicating community-acquired bacterial meningitis in adults.

Methods: Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2009.

Results: Hydrocephalus was diagnosed in 26 of 577 episodes (5%) and was classified as communicating hydrocephalus in all but 1 patient. The majority of patients (69%) presented with hydrocephalus on admission. Most common causative bacteria were Streptococcus pneumoniae (in 14 patients, 54%) and Listeria monocytogenes (in 4 patients, 15%). Thirteen patients died (50%) and 18 had an unfavorable outcome (69%). Hydrocephalus was an independent predictor of death in a multivariate analysis (odds ratio 7.81, 95% confidence interval 2.91-20.8). Six patients underwent an intervention: 2 patients (8%) had serial lumbar punctures; 4 patients (15%) underwent external ventricular CSF catheter placement. Median time from diagnosis of hydrocephalus to CSF shunting was 12 hours (range 0-4 days). All patients who underwent CSF shunting died or had a poor outcome.

Conclusions: Hydrocephalus complicates community-acquired bacterial meningitis in 5% of adult cases and is associated with high fatality rates. A minority of patients underwent neurosurgery and outcome was uniformly poor in these patients.