Bacterial meningitis
Complicações
Local inflammatory responses to bacteria, altered cerebral blood flow, and vasculitis lead to cerebral edema. Lumbar puncture is contraindicated in patients with suspected elevated intracranial pressure (ICP).
Despite weak evidence certainty, the most recent literature suggests improved patient outcomes with the use of treatment strategies aiming to normalize ICP.[153] Patients with evidence of elevated ICP should be intubated and ventilated to maintain adequate oxygenation and normocapnia. Patients should be positioned with heads elevated 30° and in a midline position, and stimuli reduced by sedation and minimal handling.
Seizures should be treated aggressively.
Mannitol, furosemide, dexamethasone, and short periods of hyperventilation may be indicated for the acute treatment of severely elevated ICP.
A potential complication of bacterial meningitis that can improve with time.
More subtle consequences of bacterial meningitis that may not be apparent for several years after infection.
Survivors of severe infections may have emotional, learning, and behavioral disorders that require multidisciplinary assessment and treatment.
Should be treated aggressively with benzodiazepines. Patients with seizure disorders generally require long-term anticonvulsant therapy.
Present in one third of patients. Commonly associated with Haemophilus influenzae and Streptococcus pneumoniae.
Usually asymptomatic and resolves spontaneously.
Sensorineural hearing loss occurs in 25% to 35% of patients after pneumococcal meningitis and in 5% to 10% of patients after Haemophilus influenzae type b meningitis.
While rare, brain abscesses (epidural, subdural, intracerebral) may occur in newborns with gram-negative bacterial meningitis.
Uncommon but occasionally lethal disease caused by systemic complications. In most cases it is caused by transvenous catheter lines.
Should be considered in patients with an impaired level of consciousness, seizures, fluctuating focal signs, and stroke.
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