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Worldwide, bacterial meningitis is among the top ten causes of infection-related death. Although effective antimicrobial treatment is available and administered, fatality rates are still very high. Furthermore, 50% of affected patients suffer long-term sequelae due to severe complications, such as hydrocephalus, brain edema, cerebrovascular complications and ventriculitis. The following short review summarizes the most important complications and the neurocritical care management of acute bacterial meningitis in adults, illustrated by an instructive case report.