PT  - JOURNAL ARTICLE
AU  - Marjolein J. Lucas
AU  - Matthijs C. Brouwer
AU  - Arie van der Ende
AU  - Diederik van de Beek
TI  - Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score
AID  - 10.1212/NXI.0000000000000009
DP  - 2014 Jun 01
TA  - Neurology - Neuroimmunology Neuroinflammation
PG  - e9
VI  - 1
IP  - 1
4099  - http://nn.neurology.org/content/1/1/e9.short
4100  - http://nn.neurology.org/content/1/1/e9.full
SO  - Neurol Neuroimmunol Neuroinflamm2014 Jun 01; 1
AB  - 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.ICP=intracranial pressure