Neurological sequelae after bacterial meningitis

The frequency of residual neurological abnormalities after bacterial meningitis in children is about 10-30%. Long-term sequelae include hearing deficits (7-19%), epilepsy (4-7%), mental retardation (10-15%), neuropsychological deficits, behaviour problems, severe (2-10%) and subtle motor abnormalities, cranial nerve paresis (2-7%), visual impairment (2-4%) and hydrocephalus (1-2%). Neonates have a higher risk of neurological sequelae after meningitis than older children, especially when it is caused by gram-negative enteric bacilli. After tuberculous meningitis 40-90% of the children have neurological deficits, depending on the stage. Risk factors for neurological sequelae are young age, type of pathogen (tuberculosis, group B streptococci, gram-nega-tive enteric bacilli, and pneumococci are associated with worse outcome than H. influenzae and meningococci), delay in the start of antimicrobial treatment, acute neurological symptoms, and low glucose level, high number of bacteria and high intensity of host inflammatory response in the cerebrospinal fluid (marked rise in levels of tumour necrosis factor, interleukin-1, proslagland-ins). After recovery early hearing evaluation and careful follow-up are required for full assessment of any sequelae.