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. 2014 May 15;1(1):e9.
doi: 10.1212/NXI.0000000000000009. eCollection 2014 Jun.

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

Marjolein J Lucas  1 , Matthijs C Brouwer  1 , Arie van der Ende  1 , Diederik van de Beek  1
Affiliations

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

Marjolein J Lucas et al. Neurol Neuroimmunol Neuroinflamm. .

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.

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Figures

Figure 1
Figure 1. Distribution of scores on Glasgow Coma Scale for adults presenting with community-acquired bacterial meningitis
Figure 2
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.
See this image and copyright information in PMC

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