Die eitrige Meningoenzephalitis - Untersuchungen zum Verlauf und zur Prognose

Abstract

The course of acute purulent meningitis and meningocephalitis was investigated in 101 patients using records and a questionnaire directed to all patients. Patients who survived meningoencephalitis were asked to come to a neurological examination. Neuropsychological status, EEG and Tc-HMPAO-Spect were also performed in these patients. The patients were treated with a combination of three antimicrobial agents which was commonly used at our hospital during the investigation time consisting of penicillin, a cephalosporine of the third generation and an aminoglycoside. 40% of the patients suffered from more or less severe neurologic sequelae; remaining cognitive deficits were also frequent. On the whole there was a tendency towards improvement in patients who suffered from less severe deficits at the time of discharge from hospital, patients with more severe deficits also showed slight improvement but generally did not reach a restitutio ad integrum. Regarding this, in our opinion a broad initial antimicrobial therapy should be used, although a statistically significant improvement of the patient's outcome by this could not be shown. Lethality as well as the frequency of complications do not seem to differ over many years although antimicrobial and intensive care treatment were improved. Thus, the outcome seems to depend largely on the occurrence of secondary focal complications or brain oedema.

Cognitive Impairment in Adults with Good Recovery after Bacterial Meningitis

“…In these studies, highly selected groups of adult patients, of whom 54%-70% had neurologic sequelae, were examined retrospectively. Psychometric findings included de-creased speed of cognitive and psychomotor performance, reduction in visuoconstructive capacity, and high scores on depression scales, all which were comparable to our findings [10][11][12][13]. However, the studies described impairments in almost all neuropsychological domains, and cognitive impairment was correlated with presence of neurologic sequelae.…”

“…Results of neuropsychological evaluation of adult patients after bacterial meningitis have been described in only a few studies [10][11][12][13]. In these studies, highly selected groups of adult patients, of whom 54%-70% had neurologic sequelae, were examined retrospectively.…”

Relationship between short-term outcome and occurrence of cerebral artery stenosis in survivors of bacterial meningitis

“…The histological inflammatory changes demonstrated for the MCA and ACA can also be found in the basilar artery (BA) [39]. However, the involvement of the BA or its branches, including the posterior cerebral artery (PCA), in the meningitic disorder seems to be rarely found by clinical, computed tomographic, angiographic and transcranial Doppler ultrasound (TCD) examination [15,19,24,26,27,29,40].…”