Two Rare Complications of Acute Bacterial Meningitis Subarachnoid Hemorrhage and Intraventricular Hemorrhage in a Single Frame: A Case Report

Meningitis can lead to severe and disabling neurological consequences if diagnosis and treatment is delayed. There are multiple complications associated with meningitis including cerebrovascular accidents. Subarachnoid hemorrhage is one of the rarest complications and carries worse prognosis. Early diagnosis and immediate management is the key for survival in patients with intracranial hemorrhage secondary to meningitis. This is a case of 65-year-old male with no established premorbid who presented with 2 weeks history of high-grade fever and altered sensorium for 3 days. On examination he was vitally stable but irritable with Glasgow coma scale of 11/15. Neck stiffness was positive with negative Kernig's and Brudzinski's sign. There was no other focal neurological deficit. Respiratory, CVS, GIT and Musculoskeletal examination was unremarkable. Complete blood picture showed raised leucocyte count. C-reactive protein and Erythrocyte sedimentation were also raised. Liver function tests, Renal function tests, Electrolytes, Urine routine examination, Electrocardiography and chest x-ray was normal. CT brain was done which was normal. Lumber Puncture was done which was suggestive of bacterial meningitis. Antibiotics were started and the patient's GCS improved to 15/15. After 3 days patient GCS suddenly dropped to 8/15. CT brain was repeated which showed subarachnoid hemorrhage with intraventricular extension and mild obstructive hydrocephalous. External Ventricular Drain was placed and patient improved significantly