title: Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score.
abstract: OBJECTIVE
  In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown.
  
  
  METHODS
  We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012.
  
  
  RESULTS
  Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died.
  
  
  CONCLUSIONS
  Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.
authors.affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.
authors.forename: Marjolein J
authors.initials: MJ
authors.lastname: Lucas
authors.affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek