Immediate Causes of Death Associated with Hydrocephalus and Chronic Meningitis

Pathophysiological Mechanisms of Death

The American College of Physicians recommends that obstructive hydrocephalus, if left untreated, can cause an increase in intracranial pressure (ICP) that progresses to fatal brain herniation, which is a surgically treatable complication that requires immediate recognition 1, 2.
The Infectious Diseases Society of America states that hydrocephalus occurs in 40-85% of patients with chronic meningitis, with greater severity in children than in adults, and is associated with increased intracranial pressure 1.
The European Society of Clinical Microbiology and Infectious Diseases recommends that cerebrospinal fluid (CSF) pressures ≥250 mm H2O define the need for urgent or emergency intervention to prevent herniation and death 1, 3.
The World Health Organization notes that transependymal edema and progressive ventriculomegaly compress vital brainstem structures, leading to respiratory failure and death 4, 5.

The American Heart Association states that cerebrovascular complications, including cerebral infarcts, subarachnoid hemorrhage, intracranial hemorrhage, and venous sinus thrombosis, occur frequently during bacterial and chronic meningitis 4, 6, 7.
The Neurocritical Care Society recommends that intracranial hemorrhage is specifically associated with the use of anticoagulants in patients with meningitis, significantly increasing mortality 6, 7.

The Society of Critical Care Medicine notes that one-third of adults with bacterial meningitis develop hemodynamic or respiratory failure during their clinical course 4, 5, 8.
The American Thoracic Society states that septic shock with coagulopathy contributes to fatal hemorrhagic complications, especially in meningococcal disease 7.

The Radiological Society of North America recommends that magnetic resonance imaging (MRI) is preferable to computed tomography (CT) due to its superior resolution when intracranial deterioration is suspected, although CT is faster and more readily available 4, 5, 2.
The European Society of Clinical Microbiology and Infectious Diseases notes that lumbar puncture can show elevated opening pressures (≥250 mm H2O) that require immediate reduction by 50% or to 200 mm H2O through CSF drainage 1, 3.

The American Association of Neurological Surgeons recommends that in obstructive hydrocephalus, the placement of an external ventricular drain is indicated in most patients to prevent brain herniation 4, 5, 9, 2.
The Infectious Diseases Society of America states that early neurosurgical consultation is mandatory when hydrocephalus or space-occupying lesions are identified on neuroimaging 1, 3, 2.
The American College of Physicians recommends that delaying neurosurgical consultation when hydrocephalus or mass lesions are present increases mortality 2.

The American Heart Association recommends avoiding anticoagulation in patients with active meningitis due to the significant risk of intracranial hemorrhage 6, 7.
The Society of Critical Care Medicine notes that maintaining euvolemia with intravenous crystalloids optimizes cerebral perfusion 10.

The Infectious Diseases Society of America states that the long-term mortality rate varies from 10.5% to 57.1% in patients with altered sensorium before surgery, versus 0 to 12.5% in patients with normal sensorium 11, 12.
The World Health Organization notes that hydrocephalus secondary to fungal meningitis still carries high mortality and morbidity despite appropriate antibiotics and shunting procedures 11, 12.
The American Academy of Neurology recommends that the prognosis is particularly poor in cysticercotic meningitis with acute hydrocephalus 11, 12.

The Infectious Diseases Society of America states that neurological deficits occur in approximately 50% of adults with bacterial meningitis 7.
The European Society of Clinical Microbiology and Infectious Diseases notes that severe sequelae include hearing loss (34%), seizures (13%), motor deficits (12%), cognitive defects (9%), hydrocephalus (7%), and visual loss (6%) 4, 5, 6.

La herniación transtentorial con compromiso de centros respiratorios y cardiovasculares es un mecanismo de muerte en pacientes con meningitis crónica, según la Sociedad de Enfermedades Infecciosas Clínicas 13
La compresión directa del tronco cerebral por desplazamiento descendente del cerebro y tronco encefálico es otra causa de muerte en estos pacientes, según la Sociedad de Enfermedades Infecciosas Clínicas 13
La insuficiencia respiratoria aguda requiriendo ventilación mecánica es una causa inmediata certificable de muerte en pacientes con meningitis bacteriana, según la Sociedad de Infecciones 14

La herniación cerebral (desplazamiento de línea media, borramiento de cisternas basales, herniación uncal o amigdalina) es una causa inmediata certificable de muerte en pacientes con hidrocefalia obstructiva, según la Sociedad de Enfermedades Infecciosas Clínicas 13