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Seizures associated with meningitis
N M Rosenberg1, K Meert, D Marino
1Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201.
Abstract:
The records of 187 patients with bacterial meningitis were reviewed. Seizures were a presenting manifestation in 25 (13%). Seven (28%) of the patients with a presenting seizure had been taking antibiotics prior to the diagnosis. Four of seven pretreated patients did not have additional signs or symptoms with the seizure, while all 18 patients without treatment had additional findings (P less than 0.01). Patients developing seizures while hospitalized had a poorer outcome than those without seizures. Patients with bacterial meningitis may present with only a seizure if they have been taking oral antibiotics; therefore, all patients taking antibiotics who develop a seizure require a lumbar puncture to exclude meningitis.
Insights
Bacterial meningitis can present solely as a seizure, especially in patients pretreated with antibiotics. Prompt lumbar puncture is crucial for early diagnosis and better outcomes in such cases.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Bacterial meningitis is a serious infection affecting the central nervous system.
- Seizures are a known complication of meningitis, but their presentation can vary.
- Antibiotic pretreatment may alter the typical clinical manifestations of meningitis.
Purpose of the Study:
- To investigate the clinical presentation of bacterial meningitis, particularly seizures.
- To determine the impact of prior antibiotic use on seizure presentation in meningitis patients.
- To assess the outcomes of patients with meningitis-associated seizures.
Main Methods:
- Retrospective review of 187 patient records with bacterial meningitis.
- Analysis of seizure presentation, including pretreatment with antibiotics.
- Comparison of clinical findings and outcomes between different patient groups.
Main Results:
- Seizures were observed in 13% of bacterial meningitis patients (25/187).
- Of patients with presenting seizures, 28% (7/25) had prior antibiotic exposure.
- Pretreated patients with seizures showed fewer additional symptoms compared to untreated patients (P < 0.01).
- Hospitalized patients who developed seizures had poorer outcomes.
Conclusions:
- Bacterial meningitis may present with isolated seizures in patients taking antibiotics.
- Antibiotic pretreatment can mask other meningitis symptoms, leading to delayed diagnosis.
- Lumbar puncture is essential for all patients on antibiotics who experience seizures to rule out meningitis.