Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion

Wang, Xianshu; Zhang, Xiaoru; Cao, Hongbin; Jing, Shiyuan; Yang, Zhiguo; Cheng, Zhenghai; Liu, Ye; Li, Xin; Gao, Feifei; Ji, Yuanqi

doi:10.12659/msm.895747

Cited by 9 publications

(10 citation statements)

References 7 publications

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“…It may leave sequelae and even lead to death (Bryan et al 1990; Carroll and Carroll 1994; Feigin and Dodge 1976; Grimwood 2001; Nottidge 1985; Olanrewaju et al 1991; Saez-Llorens and Mccracken 2003; Wang et al 2015). PM is easily misdiagnosed because infants and young children lack the ability to describe their conditions, and its symptoms are varied.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis on 430 cases of infantile purulent meningitis

Jiang

2016

SpringerPlus

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BackgroundPurulent meningitis (PM) usually caused by a variety of pyogenic infection, is a kind of central nervous system infectious disease mostly common in children. It is easily misdiagnosed and its symptoms are varied. Excessive application of broad-spectrum antibiotics results in increased sickness and death of infants and young children. In this study, clinical data of 430 cases of PM in infants were analyzed to summarize the clinical experiences so as to achieve early diagnosis and early treatment of PM.ResultsMale-to-female ratio was 1.61:1, and the median age of incidence was 0.42 years. May was the modal month of onset (11.7%). Main clinical manifestations were fever (89.3%), vomiting (67.2%), mental fatigue (62.1%), anterior fontanelle full/bulging/high tension (54.2%), convulsion (52.6%), and meningeal irritation sign (24.7%). Cerebrospinal fluid (CSF) bacterial culture was done for 420 cases, of which 1.2% cases were positive. Blood culture was done for 146 cases of which 15.1% were positive. 175 (40.7%) cases had complications, among which 133 cases (76.0%) were subdural effusion, 21 cases (12.0%) were epilepsy.ConclusionInfantile PM is common in Spring, and May is the modal month of onset. The CSF/blood pathogen detection rate is very low and it is difficult to find evidence of cause. Fever, vomiting, mental fatigue and anterior fontanelle full/bulging/high tension, convulsion are the main clinical manifestations on which diagnosis depends. For those children diagnosed as PM and still having recurrent fever and prominent anterior fontanelle after treatment, clinicians should consider the probability of subdural effusion and treat them with brain imaging test on time.

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Section: Introductionmentioning

confidence: 99%

Clinical analysis on 430 cases of infantile purulent meningitis

Jiang

2016

SpringerPlus

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“…Some other scholars believe that benign external hydrocephalus may be related to impaired absorption of CSF by arachnoid granules [18,19]. In addition, one possibility for benign external hydrocephalus formation is exudate caused by subdural in ammation [20]. In our clinical practice, we have found a very high number of infants and children with benign external hydrocephalus, which often persists until the age of 2 to 3 years [14].…”

Section: Discussionmentioning

confidence: 71%

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Yang

Wang

2023

Preprint

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Purpose Acute traumatic subdural effusion with hemorrhage (ATSEH) is a common type of head trauma in children. However, there is considerable variation in the previous literature regarding the clinical presentation, pathogenesis, and treatment strategies of ATSEH in children. The purpose of this study was to summarize the clinical features of ATSEH in children as well as to explore their treatment strategies. Methods There were 79 cases of ATSEH studied retrospectively at a pediatric teaching hospital over an 7-year period. The children ranged in age from 1 month to 3 years, with an average age of 8.51(4.33,11.00) months. We analyzed the relationship between the outcome of ATSEH treatment and factors such as age, sex, symptoms, signs, coagulation function, internal environmental homeostasis, and imaging materials. The mean follow-up time was 57.56(34,82) months. The mRS score was used for patient prognosis. Results 27 out of 79 (34.2%) children showed subtle findings. Impaired consciousness was observed in 26.4% of patients. 52 out of 79 (65.8%) children presented with overt neurological symptoms and signs, with vomiting was t the most common symptom. 51 of 79 children (64.6%) presented with increased fontanelle tone. 32 out of 79 (40.51%) patients required operative management. 73 of the 79 patients (92.4%) had a good prognosis. The patients in the surgical group showed reduced fibrinogen (<1.5g/L) in 53.1%, low hemoglobin (88.56±17.21) and hyponatremia (133.50±3.76). Conclusions Patients with an age of 9.07(4.31,8.30) presenting with increased impairment of consciousness and increased anterior fontanelle tone are the basis for surgical treatment. Through the treatment of patients with ATSEH, we have found that the essence of ATSEH is an impairment of cerebrospinal fluid circulation triggered by subdural hemorrhage, which leads to acute hydrocephalus. In patients with ATSEH with malignant cranial hypertension, the timely subdural drainage is the key to treating and reducing serious complications. Prevention and correction of hypofibrinogen and hyponatremia are important aspects of the treatment of ATSEH in children that cannot be ignored.

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“…However, ACS combined with BM can lead to intracranial empyema, and drainage is usually performed for intraventricular empyema. Drainage in children with NCS was mainly done to treat severe subdural empyema ( 28 ). Children with NCS used more hormones, which may be related to severe systemic inflammatory response, MODS, and shock.…”

Section: Discussionmentioning

confidence: 99%

Bacterial meningitis in children with an abnormal craniocerebral structure

Pan

Song

et al. 2023

Front. Pediatr.

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BackgroundWe studied the causative pathogens, clinical characteristics, and outcome of bacterial meningitis in children with an abnormal craniocerebral structure.MethodsA retrospective single-center study was conducted on children aged in the range of 29 days to 14 years by using data obtained from the pediatric intensive care unit in Shengjing Hospital between January 2014 and August 2021. All children were diagnosed with bacterial meningitis. They were divided into complex and simple groups by taking into account the presence of an abnormal craniocerebral structure before they contracted bacterial meningitis. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes.ResultsA total of 207 patients were included in the study (46 in the complex group and 161 in the simple group). Patients in the complex group had a lower mortality rate (6.5% vs. 11.2%, p < 0.05), positive blood culture (13.0% vs. 34.8%; p < 0.05), multiple organ dysfunction syndrome (0% vs. 9.3%; p < 0.05), and shock (2.2% vs. 9.3%; p = 0.11). These patients were more often detected with neurological sequelae (80.4% vs. 53.4%; p < 0.05), cerebrospinal fluid drainage (50% vs. 15.5%; p < 0.05), nosocomial infection (54.3% vs. 3.1%; p < 0.05), and multidrug-resistant bacteria (62.5% vs. 55.6%, p = 0.501). In patients in the simple group, infection was mostly confined to the nervous system.ConclusionBacterial meningitis patients with an abnormal craniocerebral structure had fewer bloodstream infections, lower mortality rates, and higher incidence rates of neurological sequelae. Pathogens were more likely to be nosocomial and multidrug-resistant bacteria.

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Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion

Cited by 9 publications

References 7 publications

Clinical analysis on 430 cases of infantile purulent meningitis

Clinical analysis on 430 cases of infantile purulent meningitis

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

Bacterial meningitis in children with an abnormal craniocerebral structure

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