Prognosis and complications of acute purulent meningitis

1. Big picture

Acute purulent (bacterial) meningitis is a neurological emergency. Even with treatment it carries significant mortality and a high rate of permanent neurological sequelae. The exam wants you to know what can go wrong (complications) and what determines outcome (prognosis).

Core exam idea: Outcome depends on the organism, the patient's age and immune state, and — above all — how quickly effective antibiotics (and dexamethasone) are started. Delay in treatment is the most modifiable predictor of death and disability.