Abstract

Background: Bacterial meningitis is a dangerous infection of the central nervous system with a high probability of complications and possible fatal outcomes. The chances of full recovery can be substantially diminished when concurrent neurovascular complications are apparent, including both hemorrhagic and ischemic stroke. To successfully manage bacterial meningitis, a direct approach is required to address both the responsible pathogen and neurological complications that can be evoked by increased intracranial pressure, stroke, and seizures. Clinicians continue to face challenges with determining proper and optimal pharmacotherapy in patients with stroke complicating bacterial meningitis.

Objective: The objective of this study is to examine current medical protocols for non-tubercular meningitis-induced stroke, to evaluate their efficacy, and to discuss a standard algorithm for potential future clinical trials.

Methods: We conducted a qualitative scoping review with adherence to PRISMA guidelines. The systematic search focused on patient outcomes and management options available to patients with non-tubercular meningitis and associated strokes. The search strategy used the following databases: PubMed, Embase, Medline, and Cochrane reviews. We operationalized keywords: “Bacterial Meningitis”, “Stroke”, “Management” and utilized an advanced search via Boolean operators (“AND” and “OR”). Our inclusion criteria specified that studies must have been published between 1990 and 2022 and focused on adult patients over 18 years of age who were diagnosed with non-tubercular meningitis and strokes. Analytic methods only included relevant: case reports, comparative studies, randomized controlled trials, and retrospective studies.

Results: A total of 44 articles were identified, with 34 satisfying the eligibility criteria. Data extracted from these articles suggest routine management involving the simultaneous use of intravenous dexamethasone and broad-spectrum antibiotics as the standard care for patients with acute bacterial meningitis to reduce neurologic complications and mortality. Other studies have suggested administering classes of antibiotics in combination with antihypertensive medication and cranial surgical therapies to reduce intracranial pressure. A combination of other therapies, such as antihypertensive medication and cranial surgical therapies have been explored with promising results.

Conclusion: Strategic management is crucial for patient recovery, considering the substantial risk, wide spectrum of complications, and fatal outcomes from this meningeal infection. The results of this review suggest the use of antimicrobial therapy with intravenous adjunct dexamethasone as the standard of care for patients with stroke complications due to acute bacterial meningitis. It is imperative to accurately diagnose the causative pathogen to determine the remaining treatment course. Lastly, the findings of our scoping review offer valuable insight to direct future clinical trials. Further investigation into treatment algorithms for patients with meningeal infection complicated by stroke and/or increased intracranial pressure is still needed.