Stroke and Bacterial Meningitis in Children

We conducted an extensive literature review of neurological manifestations associated with bacterial meningitis in children worldwide, including both developed and developing nations. Our goals were to investigate the spectrum of neurological abnormalities and factors that facilitate or complicate recovery. The studies we reviewed included patients from the neonatal period through adolescence. We analyzed approximately two dozen papers, which included several cases, case series, and research reports. Initially, we searched on Pubmed, NIH, and Google Scholar for articles using keywords “Pediatrics”, “Meningitis” “Neurological Complications”, and “Stroke”. We then screened the abstracts. If they focused on a pediatric population, meningitis, and its neurological sequelae, the publications were included in the review. Articles were excluded if they were focused on adults, did not follow patients after discharge, or assessed outcomes other than neurological recovery. The age of less than a year was found to be the most significant predictor of poor neurological outcome. Other risk factors included delay in initiation of treatment, hydrocephalus, involvement of brain parenchyma, requirement for use of dexamethasone or more than two antibiotics, very low CSF glucose, very high CSF protein, and alteration of consciousness at presentation. The organism causing infection is also an important predictor of prognosis. The majority of complications occur in infections with Streptococcus pneumoniae, Haemophilus influenzae, and gram negative rods. Our findings highlight variables which influence the likelihood of persisting neurological complications of bacterial meningitis in children. This information can be used to educate parents about potential consequences of meningitis and the importance of vaccination for children's health.