Overall
Outcome really depends on the type and location of the CNS infection, as well as patient factors such as age and comorbidities
Mortality world-wide of around 20%
Neurological complications affect 20% of survivors, more common after pneumococcal meningitis
The most common neurological deficit is hearing loss, but can also include seizures, motor impairment, or cognitive disturbances.
Disseminated meningococcemia, often associated with meningococcal meningitis, can lead to limb ischaemia requiring amputation (fortunately, this is relatively rare; ~3%)
Good outcomes, with relatively low mortality (less than 1%) or neurological sequelae
On the other hand, viral encephalitis has poor outcomes
The mortality of Herpes encephalitis approaches 15% even with appropriate treatment, and at least 40% of patients have long term neurological sequelae
Prognosis varies with patient risk group and the pathogen in question, but is poor overall, and disease relapse is common.
Mortality ranges from 7% (blastomycosis) to approaching 90% (aspergillosis).
In patients with HIV, CNS cryptococcus infections have high acute mortality (~10%), and relapse after treatment is high.
In immunocompetent individuals, CNS cryptococcal infections are still often fatal, in part due to delayed diagnosis (one study measured an average of 44 days between symptom onset and diagnosis in immunocompetent patients).
The 3-month mortality of cryptococcal meningitis is 20%, irrespective of immune status, even with full treatment.
Poor prognosis, even with appropriate treatment
24% mortality rate
In HIV positive patients, mortality approaches 50%
Half of patients who survive will have neurological sequelae
In the pre-CT era, mortality ranged from 40–60%.
With advances in antibiotics, surgery, and the improved ability to diagnose and follow response with CT and/or MRI, mortality rate has been reduced to < 10%
Morbidity is high with permanent neurologic deficit or seizures common
- 45% are left with some form of neurological disability
- 27% suffer seizures
- 29% have a degree of hemiparesis
Mortality has dropped from near 100% in the pre-antibiotic era to ≈ 10%.
Neurologic deficits tend to improve following treatment, but were present in 55% of patients at the time of discharge from the hospital.
Age ≥ 60 years, obtundation or coma at presentation, posterior cranial fossa SDE and SDE related to surgery or trauma (rather than sinusitis) carry a worse prognosis.
30% of people who survive a cranial subdural empyema will develop seizures
REF
Mortality 4–31%
Higher mortality in older patients and in those paralyzed before surgery
Patients with severe neurologic deficit rarely improve, even with surgical intervention within 6–12 hrs of onset of paralysis, although a few series have shown a chance for some recovery with treatment within 36 hrs of paralysis.
Reversal of paralysis of caudal spinal cord segments if present for more than a few hours is rare’
The exception is TB of spine: 50% return of function.
Mortality is usually due to original focus of infection or as a complication of para/tetraplegia (e.g. pulmonary embolism).