Clinical Case Database / Category: Patient Management

Bacterial menengitis

Publication details

Dr Nancy TH Colchester, Dr Ashwin A Pinto
Foundation Years Journal, volume 8, issue 3, p.14 (123Doc Education, London, March 2014)


We describe a case of an elderly lady found poorly responsive at home, in whom the final diagnosis was pneumococcal meningitis. She later developed a cerebral abscess: an uncommon complication but one that all doctors should be aware of given its implications for treatment. We discuss learning points key to assessment of such patients by junior doctors: (1) neurological assessment of a confused or drowsy patient with emphasis on localising the cause of their poor conscious level; (2) initial differential diagnosis in terms of aetiology, including whether their poor conscious level is due to a primary neurological condition or secondary to a systemic illness; (3) understanding the CSF results; (4) specific points regarding risk factors and complications of pneumococcal meningitis, the commonest cause of bacterial meningitis in adults.

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Dr Nancy TH Colchester

Specialist Registrar in Neurology
Wessex Neurological Centre
University Hospital Southampton
Tremona Road
Southampton, SO16 6YD

Dr Ashwin A Pinto

Consultant Neurologist
Wessex Neurological Centre
University Hospital Southampton
Tremona Road
Southampton, SO16 6YD


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2. Ropper AH, Brown RH. Adams and Victor’s Principles of Neurology, 8th edn. New York: McGraw-Hill 2005.
3. Falcone S, Post M. Encephalitis, cerebritis, and brain abscess: pathophysiology and imaging findings. Neuroimaging Clin N Am 2000,
4. De Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Eng J Med 2002, 347:1549-56.
5. Van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol 2010, 9(3):254-63.
6. British Infection Society. Early management of suspected bacterial meningitis and meningococcal septicaemia in immunocompetant adults. Journal of Infection 2003; 46:75-7.


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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