The use of clinical scales in depicting cerebrovascular complications in bacterial meningitis

To evaluate the utility of different scales for clinical assessment, over t ime, in acute bacterial meningitis, the authors investigated 53 consecutive patients (mean age 53 +/- 17 years). Clinical status on days 1, 3, 5, 8, a nd 14 after admission was determined by the Scandinavian Stroke Scale (SSS) , Glasgow Coma Scale (GCS), and Hunt and Hess Scale (HH), and, on day 21, b y the Glasgow Outcome Scale (GOS). Transcranial Doppler examinations were p erformed serially to assess for disease-related arterial narrowing. This wa s observed in 27 patients (51%) within 2 weeks of admission. All scales wer e observed to correlate with the 21-day GOS. Patients with cerebral arteria l narrowing had significantly decreased SSS scores between days 1 and 8 and worse GCS and HH scores between days 3 and 5. Mean blood flow velocity in the middle cerebral artery on days 5 and 8 significantly correlated with GO S (r = 0.268, P < .008; r = -0.324, P < .003, respectively). The use of suc h clinical scales allows standardized assessment of patients with bacterial meningitis and provides prognostic information. Cerebral arterial narrowin g was observed to correlate with neurologic impairment.