Neurologic evaluation of the patient with acute bacterial meningitis.

Major advances in our understanding of the pathophysiology of bacterial meningitis have been made in the past decade. It is likely that interventional strategies that mediate the effects of vasoactive metabolites and neuronal and glial toxins will improve the outcome of patients with meningitis as well as other neurologic disorders. Of critical importance, as demonstrated in the case history, is the realization that many of the serious complications of meningitis occur very early in the course of the disease. If new treatment strategies are to be effective, they should be started as soon as possible. Emerging technologies such as proton magnetic resonance spectroscopy may be of benefit in helping physicians decide which patients require treatment.