Post-Traumatic Meningitis Is a Diagnostic Challenging Time: A Systematic Review Focusing on Clinical and Pathological Features

Abstract

Post-traumatic meningitis is a dreadful condition that presents additional challenges, in terms of both diagnosis and management, when compared with community-acquired cases. Post-traumatic meningitis refers to a meningeal infection causally related to a cranio-cerebral trauma, regardless of temporal proximity. The PICO (participants, intervention, control, and outcomes) question was as follows: “Is there an association between traumatic brain injury and post-traumatic meningitis?” The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. Studies examining post-traumatic meningitis, paying particular attention to victims of traumatic brain injury, were included. Post-traumatic meningitis represents a high mortality disease. Diagnosis may be difficult both because clinical signs are nonspecific and blurred and because of the lack of pathognomonic laboratory markers. Moreover, these markers increase with a rather long latency, thus not allowing a prompt diagnosis, which could improve patients’ outcome. Among all the detectable clinical signs, the appearance of cranial cerebrospinal fluid (CSF) leakage (manifesting as rhinorrhea or otorrhea) should always arouse suspicion of meningitis. On one hand, microbiological exams on cerebrospinal fluid (CSF), which represent the gold standard for the diagnosis, require days to get reliable results. On the other hand, radiological exams, especially CT of the brain, could represent an alternative for early diagnosis. An update on these issues is certainly of interest to focus on possible predictors of survival and useful tools for prompt diagnosis.

A Retrospective Study of Recurrent Bacterial Meningitis in Children: Etiology, Clinical Course, and Treatment

“…The underlying cause is a trans-dural communication between the meningeal space and paranasal sinuses or skin [ 38 ]. Bacterial penetration of the subarachnoid space may occur directly through a breach in the skull and adjacent soft tissues, which is the cause of meningitis [ 39 ]. Patients with head injury have the highest risk of acquiring recurrent bacterial meningitis [ 38 ].…”

Steroid-Responsive Post-Traumatic Persistent Neutrophilic Meningitis

“…Here we presented a case of steroid-responsive post-traumatic persistent neutrophilic meningitis (SPNM). Post-traumatic meningitis is a dreadful condition that presents as a diagnostic and therapeutic challenge compared to community-acquired meningitis [ 5 ]. Diagnosing meningitis in patients with a recent neurosurgical procedure or head trauma can be challenging due to concurrent neurological deficits and/or decreased consciousness.…”

Pediatric Abusive Head Trauma: A Systematic Review

“…AHT represents a major cause of fatal head injury in infants and young children, but the diagnosis is not straightforward and represents a medical, forensic, and social challenge, achievable only through a multidisciplinary approach. The diagnosis is primarily based on an accurate clinical history, a thorough ophthalmological examination (eye fundus) and neuroimaging to detect signs of brain and spinal injury [61]. Retinal hemorrhages are a reliable means of proving the diagnosis AHT both in vivo and postmortem; therefore, in case of postmortem evaluation, histological examination of the retinal layer could allow confirmation of the clinical diagnostic hypothesis.…”