Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for subdural empyema?

Yalçınkaya, Rümeysa; Tanır, Gönül; Kaman, Ayşe; Öz, Fatma Nur; Teke, Türkan Aydın; Durmuş, Sevgi Yaşar; Ekşioğlu, Ayşe Seçil; Aycan, Ahmet Emre; Ceyhan, Mehmet

doi:10.1007/s00431-020-03791-5

Cited by 4 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The clinical features of our cases with subdural empyema were compatible with those reported in the literature [20,23,35]. A recent study concluded that subdural empyema should be considered in patients with persistent fever while on adequate antibiotic therapy or above 4.65 protein-to-glucose ratio in the CSF [16]. Among all meningitis-related complications, subdural empyema was often identified earlier [21].…”

Section: Discussionsupporting

confidence: 85%

“…A decision must be made for highly suspicious presentations to arrange intracranial images or continuous monitoring, which is necessary for prompt intervention after early diagnosis [23,24]. In our cohort, cases of subdural empyema had a higher WBC count, lower glucose level and higher protein level, which indicated more severe intracranial inflammation [6,16,37]. Most of the subdural empyema were direct bacterial invasions, and it is reasonable that these patients were more likely to have concurrent bacteremia, more severe clinical manifestations and neurological sequelae at discharge.…”

Section: Discussionmentioning

confidence: 76%

“…Previous studies have concluded that subdural empyema is a neurosurgical emergency, potentially fatal, requiring a high need for clinical awareness. [14][15][16]. A recent surveillance study found that subdural effusion and/or empyema was noted in 21.7% of pediatric patients with acute bacterial meningitis, accounting for the most common intracranial complications [17].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis

Lee,

Tsai,

Hsu

et al. 2024

Antibiotics

View full text Add to dashboard Cite

Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis

Lee,

Tsai,

Hsu

et al. 2024

Antibiotics

View full text Add to dashboard Cite

show abstract

“…The most common pathogens in community-acquired bacterial meningitis were reported to be Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae[ 6 ]-Streptococcus pneumoniae was detected in the present case. An elevated CSF protein/glucose ratio > 4.65 was also suggested to be an indicator of aggravation of meningitis or transformation into SDE[ 7 ]. The protein/glucose ratio in the present case was 18.9, which was significantly higher than the reference estimate.…”

Section: Discussionmentioning

confidence: 99%

Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report

Yang¹,

Chen²,

Zhang³

et al. 2023

World J Clin Cases

View full text Add to dashboard Cite

BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae. CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment. CONCLUSION Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.

show abstract

“…Meningitis can progress to subdural empyema, particularly in the 12-20 month age group when little is known about the disease's features. Long-term neurologic consequences and death may result from delayed diagnosis and treatment [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Scope of an Integrative Neurophysiotherapy Approach in Achieving Gross Motor Milestones in a Child with Meningitis: A Case Report

Pathan,

Seth,

Deodhe

2023

Cureus

View full text Add to dashboard Cite

Meningitis caused by bacteria, which is an inflammation of the meninges affecting the pia, arachnoid, and subarachnoid space, is still one of the leading causes of death and morbidity in infants and young children. Neisseria meningitidis , group B streptococcus (GBS), Haemophilus influenzae type B (Hib), Listeria monocytogenes , and Streptococcus pneumoniae have been found to be the most frequent causative agents. Infants and children can have modest, fluctuating, non-specific, or even absent clinical signs of bacterial meningitis. They may include bulging fontanelles, vomiting, diarrhea, respiratory distress, hypothermia, lethargy, irritability, poor feeding, and fever in babies. In this case report, an 18-month-old child presented to a local hospital with complaints of multiple episodes of high-grade fever. After 10 days, his symptoms worsened and he experienced two episodes of seizures at one-day intervals at night. He was taken to Acharya Vinoba Bhave Rural Hospital for further management. Blood investigations revealed seropositive results for dengue virus infection. On MRI and CT scan, it was diagnosed as an old case of subdural hematoma in the right frontotemporal region of the brain. The patient was on intravenous ceftriaxone and phenytoin. Gross motor developmental milestones in children with meningitis can be improved with early integrative neurophysiotherapy and a goal-oriented therapeutic regimen that includes mobility exercises, proprioceptive neuromuscular facilitation techniques, positioning, oromotor retraining, neurodevelopmental techniques, and balance and coordination retraining. A complex case presents with bacterial meningitis, hydrocephalus, and seizure disorder. The bacterial infection inflames the protective membranes of the brain, causing hydrocephalus. Increased cerebrospinal fluid puts pressure on the brain, leading to seizures. Managing these interconnected conditions requires a multidisciplinary approach making it unique, involving infectious disease, neurology, and neurosurgery expertise.

show abstract

Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for subdural empyema?

Cited by 4 publications

References 20 publications

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis

The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis

Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report

Scope of an Integrative Neurophysiotherapy Approach in Achieving Gross Motor Milestones in a Child with Meningitis: A Case Report

Contact Info

Product

Resources

About