Acute Complications
What acute complication can be treated with Benzodiazepines?
Seizures
What test should be ordered (especially in children) following bacterial meningitis?
Audiology testing! (Sensorineural hearing loss is the most common complication)
Injury to what nerve is associated with facial paralysis?
Cranial nerve VII, the facial nerve.
Low blood pressure and poor perfusion during a bacterial meningitis infection may indicate what?
Septic shock!
Name some signs of Increased Intracranial Pressure. (At Least 3)
Fluctuating consciousness, Relative bradycardia and hypertension, Focal neurological signs, Abnormal posture or posturing, Seizures; Unequal, dilated, or poorly responsive pupils; Papilloedema (late sign), Abnormal ‘doll’s eye’ movements.
A child recovering from meningitis now has difficulty with school learning and short-term memory. This is an example of…
Cognitive Impairment
Cortical scarring may result from inflammation and toxin damage during a bacterial meningitis infection. What is a long term neurological complication of this?
Epilepsy.
Seizures during the early acute phase of infection and persistent neurological deficits other than sensorineural hearing loss are risk factors.
In Bacterial Meningitis, especially in Meningococcal, what is the cause of the petechial rash and a serious complication?
Meningococcemia (endotoxin-induced vascular damage)
Disseminated Intravascular Coagulation (DIC) is a further progression, leading to purpura fulminans (necrotic lesions)
What potential complication may contribute to a focal neurological deficit in meningitis?
Brain abscess
Permanent focal neurological deficits may occur after a bacterial meningitis infection. Cortical blindness could occur from damage to the...
Occipital Lobe
Diplopia may be caused by damage to this nerve...
Cranial Nerve VI, the Abducens.
What are some other organ complications that may occur during a bacterial meningitis infection?
AKI, ARDS, Ischemic Hepatitis, Septic cardiomyopathy, etc
In what situation would you NOT perform a lumbar puncture when suspecting meningitis?
(Bonus points if you can name the potential complication if you do)
Increased Intracranial Pressure
(Bonus: May increase the chance of a brain herniation due to sudden change in gradient pressure)
Raised intracranial pressure from blocked CSF pathways (hydrocephalus) may persist after meningitis and require what treatment?
Ventriculoperitoneal shunt
How does bacterial meningitis cause vision loss?
Bonus: What is the fundoscopy finding?
Increased intracranial pressure on the optic nerve.
Swollen optic disc (papilloedema) on fundoscopy.
What is Waterhouse–Friderichsen syndrome?
Bilateral adrenal hemorrhage and adrenal insufficiency. (Associated with DIC)