COMPLICATIONS OF BACTERIAL MENINGITIS Disseminated Intravascular Coagulation. This syndrome, which is also called consumptive coagulopathy, is manifested by multiple petechiae, ecchymoses, purpura, bleeding from other sur-faces, hypotension progressing to shock, and gangrene of distal extremities (see Meningococcal Disease). It is almost always seen with the meningococcal disease and is unusual in meningitis caused by other bacteria.
Temporal and Cerebellar Herniation. These complications are commonly found in fatal meningitis and may be recognized by distinct respiratory, ocular, and motor signs that indicate loss of diencephalic, midbrain, pontine, and medullary function in an orderly rostral-caudal sequence. In the presence of these signs, repeated lumbar punctures should be avoided.
COMPLICATIONS OF BACTERIAL MENINGITIS Endocarditis, most often involving the aortic valve, is’ found in 10 to 15 percent of fatal cases of pneumococcal meningitis. Pneumonia is also frequent in this setting. The rheumatic or congenital valvular disease may antedate the development of endocarditis, but frequently nor-mal valves are involved. Staphylococci and conform organisms may also be the cause of the endocarditis-meningitis syndrome. Endocarditis may be difficult to detect clinically but should be seriously considered in patients with meningitis pneumococcal, staphylococcal, and conform bacteremia, and heart murmurs.
Purulent Arthritis. Purulent arthritis may co w plicate pneumococcal, meningococcal, and staphylococcal meningitis. In general, it responds to antimicrobials, although aspiration of synovial fluid may be necessary. Subdural Effusions. Subdural effusions have been a frequently reported complication & Hemphilus meningitis but may also follow other types of meningitis in children. Prolonged unexplained fever, confusion despite adequate antimicrobial therapy and convulsions after the apparent subsidence of infection are classic manifestations of accumulating subdural fluid that is usually sterile. Aspiration of this fluid, which may need to be repeated, results in relief of symptoms.
Residual damage to the nervous system occurs in. 10 to 20 percent of patients, and is more common following pneumococcal meningitis than in-fection with influenzae and meningococci. Deafness senses-7s most Comm on the sequel of pyogenic hemiparesis, convulsive disorders, and are seen occasionally.