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Ataxia and Its Association with Hearing Impairment in Childhood Bacterial Meningitis

Roine, Irmeli MD*; Pelkonen, Tuula MD†‡; Bernardino, Luis MD; Leite Cruzeiro, Manuel MD; Peltola, Heikki MD; Pitkäranta, Anne MD§

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p 809–813
doi: 10.1097/INF.0000000000000738
Original Studies
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Introduction: Ataxia, deemed usually a minor sequela, follows childhood bacterial meningitis (BM) in up to 18% of cases. Although mostly transient and benign, it can predict permanent hearing loss and vestibular dysfunction. We explored the clinical meaning of ataxia by following its course in a large number of BM patients and examining its relation with hearing loss.

Methods: The presence, degree (no, mild, moderate and severe) and course (transient, prolonged and late) of ataxia in BM were registered prospectively by predefined criteria. These data were compared with several patient, disease, and outcome variables including hearing loss (none, moderate, severe and profound) on day 7 of treatment and at a follow-up visit 1 month after discharge.

Results: Ataxia was present in 243 of 361 (67%) patients on day 7, being slight in 21%, moderate in 38% and severe in 41%. Its course was transient in 41%, prolonged in 24% and late in 5%, whereas 30% of the patients did not present ataxia at any time. Ataxia associated most significantly not only with several measures of BM severity and suboptimal outcome (P < 0.0001), but also specifically, albeit not consistently, with hearing loss (P = 0.001). The degree of ataxia correlated with the extent of hearing loss (rho, 0.37; P < 0.0001).

Conclusions: Ataxia is more frequent and lasts longer after BM than learned from previous studies. The presence and intensity of ataxia associate with hearing loss and its magnitude.

Supplemental Digital Content is available in the text.

From the *Faculty of Medicine, University Diego Portales, Santiago, Chile; Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Pediatric Hospital David Bernardino, Luanda, Angola; and §Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Finland.

Accepted for publication January 25, 2015.

This work was supported by grants from the Sigrid Jusélius Foundation, the Helsinki University Central Hospital Research Foundation and the Foundation for Paediatric Research, Finland. The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Irmeli Roine, MD, Faculty of Medicine, University Diego Portales, Los Misioneros 2237, 7520179 Santiago, Chile. E-mail: irmeli.roine@gmail.com; Anne Pitkäranta, Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4 E, 000290 Helsinki, Finland. E-mail: anne.pitkaranta@hus.fi.

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