Bacterial meningitis is a severe
infection of the central nervous system with significant impact on survival and functional outcome. Complications are related to the release of bacterial components in the subarachnoid space closed to the brain. Three types of complications are distinguished:
septic shock that alters the
oxygen delivery,
intracranial hypertension (ICH) that may alter the cerebralperfusion pressure and severe metabolic disorders like
hyponatremia. The management is based on an early diagnosis allowing initiating
antibiotics within the first hour. An associated
corticosteroids treatment with
dexamethasone improves the prognosis of pneumococcal and
Haemophilus meningitis. The identification of
septic shock signs should be rapid to initiate fluid bolus and sometimes vasopressors in order to maintain a good organ perfusion. The detection of
altered level of consciousness is a crucial indication of ICH. Control of intracranial pressure (ICP) as well as a good hemodynamic is based on a continuous monitoring of ICP and arterial pressure in order to assure an adapted cerebral perfusion pressure. Cerebrospinalfluid (CSF) drainage is one of the most eflicient means to control ICP as resorption of CSF is often altered in
bacterial meningitis.
Seizures should be avoided, the sedation-
pain control optimized and ventilation adapted to assure normal oxygenation and normal CO₂ levels.
Hyponatremia is most often related to a
salt wasting syndrome linked to
aquaporin's deregulation. Its rapid correction is required to avoid worsening of the cerebral oedema.