The treatment and outcome of postmeningitic subdural empyema in infants

Liu, Zhuo-Hao; Chen, Nan-Yu; Tu, Po‐Hsun; Lee, Shih‐Tseng; Wu, Chieh‐Tsai

doi:10.3171/2010.4.peds09433

Cited by 34 publications

(43 citation statements)

References 21 publications

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“…The results of our study were compared with other series (Table 6). 2,[8][9][10]17,24,25 In our cohort, the mean age was 10.9 years (range 6 months-18 years), which was consistent with the reported literature (Table 6). Male children were more affected than female children in our study, which is also consistent with the published literature.…”

Section: Discussionsupporting

confidence: 91%

“…8 In an infant, the common source was secondary infection of a subdural collection following bacterial meningitis. 9 The otogenic source was the predominant origin in both the supratentorial and infratentorial compartment, although the paranasal sinus was the second most common source in the supratentorial compartment, 13 especially in older children. These findings are also similar to those in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of outcome of subdural empyema in children

Konar¹,

Gohil²,

Shukla³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to report the etiology, clinical features, microbiology, surgical outcome, and predictors of outcome of spontaneous subdural empyema (SDE).METHODSThe authors conducted a retrospective study in a tertiary hospital. Children up to 18 years of age, with a diagnosis of SDE with infective etiology, were included in the present cohort. Patients with posttraumatic, postsurgery, and tubercular origin of SDE were excluded from the study. The Glasgow Outcome Scale was used for outcome assessment at the end of 3 months. For analysis purposes, the demographic data, clinical features, radiological data, microbiology, type of surgery, and complication data were categorized, and univariate and multivariable logistic regression analyses were performed to identify the factors associated with outcome.RESULTSNinety-eight children were included in the study and the mean age was 10.9 years. Otogenic origin (34.7%) was the most common source of infection, followed by meningitis (14.3%). The mean duration of symptoms was 12 days. Seventy-six children presented with Glasgow Coma Scale (GCS) score > 8 and the supratentorial location was the most common location. Almost 75% of the children underwent craniotomy or craniectomy and the rest had burr-hole evacuation. Beta-hemolytic Streptococcus (10%) was the most common organism isolated. Cerebral venous thrombosis (CVT; 10.2%) was the most frequent complication in this cohort. The other complications were infarction (6.1%), new-onset seizure (4.1%), and bone flap osteomyelitis (4.1%). Thirteen cases had a recurrence of pus collection, which was more common in the craniotomy group than in the burr-hole group. Age (p = 0.02), GCS score ≤ 8 (OR 8.15, p = 0.001), CVT (OR 15.17, p = 0.001), and presence of infarction (OR 7, p = 0.05) were strongly associated with unfavorable outcome. In multivariable logistic regression analysis, only GCS score ≤ 8 (p = 0.01), CVT (p = 0.02), and presence of infarction (p = 0.04) had a significant impact on unfavorable outcome.CONCLUSIONSPrompt diagnosis and immediate intervention is the goal of management of SDE, especially in children as a delay in diagnosis can result in unconsciousness and secondary complications such as CVT and infarction, which adversely affect outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Predictors of outcome of subdural empyema in children

Konar¹,

Gohil²,

Shukla³

et al. 2019

Neurosurgical Focus

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“…Neonatal bacterial meningitis is a severe infectious disease that often occurs concomitantly with the onset of bacteremia, especially those caused by Group B streptococcus (GBS), E. coli or other Gram-negative pathogens [9]–[11]. Neonatal meningitis has been associated with a variety of neurologic complications including seizure, hydrocephalus, arachnoiditis, subdural empyema, and encephalopathy [12]–[15].…”

Section: Introductionmentioning

confidence: 99%

Neurological Complications after Neonatal Bacteremia: The Clinical Characteristics, Risk Factors, and Outcomes

et al. 2014

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BackgroundNeonates with bacteremia are at risk of neurologic complications. Relevant information warrants further elucidation.Study DesignThis was a retrospective cohort study of neonates with bacteremia-related neurologic complications (BNCs) in a tertiary-level neonatal intensive care unit (NICU). A systemic chart review was performed conducted to identify clinical characteristics and outcomes. A cohort of related conditions was constructed as the control group. Logistic regression analysis was used to identify independent risk factors for BNC.ResultsOf 1037 bacteremia episodes, 36 (3.5%) had BNCs. Twenty-four cases of BNCs were related to meningitis, five were presumed meningitis, and seven occurred after septic shock. The most common causative pathogens were Group B streptococcus (41.7%) and E. coli (16.7%). The major BNCs consisted of seizures (28), hydrocephalus (20), encephalomalacia (11), cerebral infarction (7), subdural empyema (6), ventriculitis (8), and abscess (4). Eight (22.8%) neonates died and six (16.7%) were discharged in critical condition when the family withdrew life-sustaining treatment. Among the 22 survivors, eight had neurologic sequelae upon discharge. After multivariate logistic regression analysis, neonates with meningitis caused by Group B streptococcus (adjusted odds ratio [OR]: 8.90, 95% confidence interval [CI]: 2.20–36.08; p = 0.002) and combined meningitis and septic shock (OR, 5.94; 95% CI: 1.53–23.15; p = 0.010) were independently associated with BNCs.ConclusionsNeonates with bacteremia-related neurologic complications are associated with adverse outcomes or sequelae. Better strategies aimed at early detection and reducing the emergence of neurologic complications and aggressive treatment of Group B streptococcus sepsis are needed in neonates with meningitis and septic shock.

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“…РОССИЙСКИЙ ВЕСТНИК ПЕРИНАТОЛОГИИ И ПЕДИАТРИИ, 2019; 64: (5) ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII, 2019; 64: (5) Николаева И.В. и соавт.…”

Section: Figure Brain Mri Of a Patient With Meningococcal Meningitisunclassified

Meningococcal meningitis complicated by subdural empyema and epiduritis in an infant

Nikolaeva

Анохин

Шайхиева

et al. 2019

Ross. vestn. perinatol. pediatr.

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Subdural empyema is a rare but terrible complication of meningococcal meningitis in children, which can be fatal. The article describes a clinical case of meningococcal meningitis, complicated by subdural empyema and epiduritis, in a three-year-old child. The development of complications was manifested by a new wave of fever, bulging of a bregmatic fontanelle and an increase in the inflammatory markers in the blood, as well as the development of neutrophilic pleocytosis after normalization of the cellular composition of the cerebrospinal fluid. The child was diagnosed on the basis of magnetic resonance imaging of the brain and spinal cord. A longterm antibiotic therapy was effective, and the surgery was not required. The development of such complications should be assumed in all cases of a prolonged course of meningitis, accompanied by an increase in the level of inflammatory markers in the blood, even in the absence of the classic symptoms of subdural empyema.

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The treatment and outcome of postmeningitic subdural empyema in infants

Cited by 34 publications

References 21 publications

Predictors of outcome of subdural empyema in children

Predictors of outcome of subdural empyema in children

Neurological Complications after Neonatal Bacteremia: The Clinical Characteristics, Risk Factors, and Outcomes

Meningococcal meningitis complicated by subdural empyema and epiduritis in an infant

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