Intensive Care Medicine

, Volume 42, Issue 8, pp 1282–1285 | Cite as

Understanding coma in bacterial meningitis

  • R. Sonneville
  • G. Citerio
  • G. Meyfroidt
Understanding the Disease


Many patients with bacterial meningitis require intensive care unit (ICU) admission because of an abnormal conscious state, and 15 % of these patients are comatose upon presentation [1]. Such comatose state at presentation is a strong indicator of poor outcome [1, 2, 3]. At disease onset, bacterial invasion and the release of bacterial compounds promote inflammation, leukocyte invasion and stimulation of microglia. Inflammatory cells release free radicals, cytokines and excitatory amino acids, causing energy failure and cell death in various brain areas involved in awareness, including brainstem nuclei in the ascending reticular formation, basal forebrain, posterior hypothalamus, and thalamus. Compromised cerebral energy metabolism has been documented by intracerebral microdialysis, with a biochemical pattern of non-ischemic mitochondrial dysfunction [4]. Understanding the mechanisms of coma in patients with bacterial meningitis represents a major challenge for ICU...


Bacterial Meningitis Cerebral Oedema Pneumococcal Meningitis Cerebral Venous Thrombosis Obstructive Hydrocephalus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Geert Meyfroidt receives funding from the Foundation for Scientific Research, Flanders (FWO) as a senior clinical investigator (1846113N).

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  1. 1.Department of Intensive Care Medicine and Infectious Diseases, INSERM U1148, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris AP-HPUniversité Paris Diderot, Sorbonne Paris CitéParisFrance
  2. 2.School of Medicine and SurgeryUniversity of Milan-BicoccaMonzaItaly
  3. 3.Neurointensive Care, Department of Emergency and Intensive CareSan Gerardo HospitalMonzaItaly
  4. 4.Department of Intensive Care MedicineUniversity Hospitals LeuvenLeuvenBelgium

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