Over a 5-year period, 8 (4.7%) of the 170 children diagnosed at Milwaukee Children's Hospital as having Hemophilus influenzae type b (HITB) meningitis developed cerebral infarction. Compared with children who did not develop infarcts or with children who developed other neurologic complications, such as subdural effusion, empyema, or meningoencephalitis, these children had significantly higher cerebrospinal fluid (CSF) leukocyte counts on initial lumbar puncture and had a greater likelihood of seizure activity. In seven of eight patients with cerebral infarction, a focal or generalized seizure heralded neurologic findings associated with abnormal radiographic studies. Two of the eight patients died, and two were permanently severely damaged. In the other four patients, there was eventual recovery from gross neurologic deficits. The mortality in patients with HITB meningitis complicated by cerebral infarction (25%) was significantly greater than that in other patients with HITB meningitis (0.6%). The pathophysiology of infarction in patients with bacterial meningitis is uncertain but may in part relate to arteriospasm. Cerebral infarction is a serious, and in the present experience, not uncommon complication of H. influenzae meningitis.