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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of Group A beta-hemolytic streptococcal meningitis are reported. One patient presented with fever, coma, seizure and was associated with skull defect whilst the other had meningitis after surgical removal of an epidural cyst. The first died but the latter completely recovered. This organism should be considered in patients with skin wounds and bacterial meningitis due to Gram-positive cocci.
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PMID:Group A beta-hemolytic streptococcal meningitis in adults. 268 69

We reviewed the medical records of 218 episodes of status epilepticus in 193 children who were admitted to the hospital between 1983 and 1987. Of the episodes, 61% were in boys and 39% in girls, with an age range of 1 month to 14 years (average, 3.2 years). The majority of episodes (73%) occurred in patients who were less than 5 years old, with 61% less than 3 years old and 28% less than 1 year old. Status epilepticus as the initial seizure occurred in 71% of episodes. In patients under 1 year of age, 75% of episodes were associated with acute causes (bacterial meningitis in 28% and electrolyte disorders in 30%), and 23% were idiopathic (19% associated with fever). In children less than 3 years old, 47% of episodes had an acute cause, 9% had a previously known seizure disorder, and 32% were idiopathic (30% associated with fever). In patients older than 3 years, 28% of episodes were associated with acute causes, 38% were known epileptics, and 13% were idiopathic (11% had fever). Overall mortality was 6%, with 1% of all episodes ending in death during the presenting seizure. We conclude that the etiology of status epilepticus is age related, with acute causes being more common in patients with a younger age at presentation. When our data are compared with other large studies in children, it appears that mortality associated with status epilepticus has decreased.
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PMID:Etiology and mortality of status epilepticus in children. A recent update. 291 Feb 65

To determine the clinical importance of CSF cultures that are persistently positive for pathogens in patients treated for meningitis with the new cephalosporins, the records of 301 infants and children with bacterial meningitis enrolled prospectively in four clinical efficacy trials of cefuroxime or ceftriaxone therapy were reviewed. CSF culture results were positive for 20 patients and they were sterile at 18 to 36 hours after start of therapy for 281 patients. Seizures, subdural effusions, and hemiparesis were found significantly more often during hospitalization in those with delayed sterilization of CSF. Children with persistently positive cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge (45% v 19%) and at follow-up (41% v 13%) and of moderate to profound hearing impairment (35% v 15%) than did those with prompt sterilization of CSF. Repeat CSF examination is a useful prognostic indicator in infants and young children with bacterial meningitis.
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PMID:Delayed cerebrospinal fluid sterilization and adverse outcome of bacterial meningitis in infants and children. 278 Jan 43

The hospital records of 85 children with bacterial meningitis were reviewed and a subset of 25 children who underwent computed tomography of the head were identified. The major stated indications for computed tomography were fever (8 patients), seizures (4 patients), signs of increased intracranial pressure (4 patients), focal neurologic dysfunction (3 patients) and recurrent meningitis (2 patients). Abnormal findings were demonstrated by computed tomography in 20 of 25 patients but in 8 patients consisted solely of nonspecific dilatation of spaces containing cerebrospinal fluid or of basilar enhancement. The yield of information that was useful either diagnostically or therapeutically was low; positive findings of obvious clinical relevance were present in only 2 cases. Computed tomography provides an accurate means of diagnosing intracranial complications of bacterial meningitis. It must be used conservatively, however, to limit expense and radiation exposure and enhance the yield of potentially relevant information. Computed tomography is indicated for children with persistent neurologic dysfunction, persistently positive cerebrospinal fluid cultures or recurrent meningitis, whereas it is of little value for children with prolonged fever alone.
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PMID:Computed tomography in bacterial meningitis of childhood. 306 62

Clinical and laboratory data on 46 patients with acute bacterial meningitis were analyzed in a retrospective survey. The incidence of bacterial meningitis in hospital admissions was 1.3% and the mortality 33%. Streptococcus pneumoniae was the most frequent etiologic agent. Mortality was highest for pneumococcal meningitis and was higher in patients over 50 years of age (83% vs 25%, p less than 0.05). The initial stage of consciousness was prognostically important. All awake patients survived, while the more impaired the consciousness (from lethargy to coma), the higher the mortality (19%, 25%, and 78% respectively). Seizures and paresis of the third cranial nerve were significantly higher in lethal cases. Brain edema was the leading cause of death (60%). The interval between hospital admission and start of antibiotic treatment was crucial for prognosis. Patients who received the first dose of antibiotics within 3 hours after admission had a mortality of 13%, while a delay of 6-24 hours increased the mortality to 3/3.
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PMID:[Prognostic factors in bacterial meningitis in adults. Retrospective analysis of 46 patients]. 311 39

Recently, advances in identifying the etiologic agent, improving antibiotic therapy, and understanding the pathogenesis of complications of bacterial meningitis have been made. The acute and long-term sequelae and their courses have been documented. Acridine orange staining of the cerebrospinal fluid may identify bacteria in children with partially treated meningitis when gram-staining is not helpful. Monoclonal antibodies for meningococcus group B antigen have been developed and may prove useful for testing cerebrospinal fluid. Several newer cephalosporins have been shown to have excellent in vitro activity against the bacteria commonly associated with meningitis. They are indicated in the treatment of infants between 4 and 8 weeks of age, children in septic shock, children with liver disease, and children with infection with gram-negative enteric agents or bacteria resistant to ampicillin and chloramphenicol. Vasculitis and cerebral infarction may result in some of the complications, such as seizures and hemiparesis, noted in children, and their consequences can be documented by various neuroimaging procedures. The prognosis for ataxia is good, while that for sensorineural deafness is poor. The majority of children will have neither intellectual deficits nor difficulty with academic achievement. An effective vaccine against Haemophilus influenzae type b has been developed and is recommended for children between 18 and 60 months of age.
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PMID:Update on bacterial meningitis. 328 49

Detection of endotoxinlike activity in cerebrospinal fluid by Limulus amebocyte lysate gelation has been suggested as a useful technique for the diagnosis of gram-negative bacterial meningitis. We prospectively screened 1,503 cerebrospinal fluid specimens with a Limulus amebocyte lysate microassay. The limit of sensitivity of the assay was 0.01 ng/ml. All specimens that were positive for endotoxinlike activity were subjected to confirmatory retesting, after which 38 (86%) remained positive. Comparison with available culture results revealed that 33 of 38 specimens (86%) were culture positive; 3 of the 5 culture-negative specimens were from patients on therapy for gram-negative bacterial meningitis, and 1 was from a neonate. The overall specificity of confirmed positive tests was 99.5%, with a positive predictive value of 97.3%. There was one false-negative specimen, giving an overall sensitivity of 97.3% and a negative predictive value of 99.9%. Endotoxinlike activities of greater than or equal to 150 ng/ml correlated with present illness of less than 2 days' duration (P = 0.024), elevated cerebrospinal fluid protein (P less than 0.05), and seizures (P = 0.004); levels of greater than or equal to 3,000 ng/ml correlated with neutropenia (P = 0.032), and levels of greater than or equal to 3.2 X 10(6) ng/ml correlated with death (P = 0.001). We conclude that the Limulus amebocyte lysate microslide gelation test has prognostic value as a sensitive, specific, simple, inexpensive screening test for gram-negative bacterial meningitis.
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PMID:Correlation of cerebrospinal fluid endotoxinlike activity with clinical and laboratory variables in gram-negative bacterial meningitis in children. 329 86

This study was conducted to demonstrate that experienced pediatricians using standard clinical indications for performing a lumbar puncture should have a higher yield of positive spinal taps than previously reported and also can detect bacterial meningitis. These indicators included temperature elevation, inability to be consoled, level of alertness, nuchal rigidity, bulging fontanel, decreased appetite, rash, referral, and febrile seizures. Eighty-two of 381 (22%) lumbar punctures were positive for pleocytosis and/or organisms. Patients were divided into two groups, consisting of those with one indicator (low risk) and those with greater than one indicator (high risk). Thirteen of 14 patients with bacterial meningitis were placed in the high risk group. The single patient in the low risk group had been pretreated with antibiotics. The positive predictive value in bacterial meningitis for a score greater than one was 5%. The average number of clinical indicators in bacterial meningitis was 3.7, versus 2.4 in viral meningitis and 1.6 without meningitis. These findings suggest that, in the absence of prior antibiotic therapy, an experienced pediatrician can clinically detect patients at high risk for bacterial meningitis. Nonbacterial meningitis cannot be as readily detected clinically.
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PMID:Clinical indicators for lumbar puncture. 336 36

A population-based cohort of 714 survivors of encephalitis or meningitis between 1935 and 1981 was followed in order to evaluate the risks of unprovoked seizures after CNS infections. The 20-year risk of developing unprovoked seizures was 6.8%, and the ratio of observed to expected cases of unprovoked seizures was 6.9. The increased incidence of unprovoked seizures was highest during the first 5 years after the CNS infection but remained elevated over the next 15 years of follow-up. The type of CNS infection and the presence or absence of seizures during the acute phase of the CNS infection greatly influenced the risks of subsequent unprovoked seizures. The 20-year risk of developing unprovoked seizures was 22% for patients with viral encephalitis and early seizures, 10% for patients with viral encephalitis without early seizures, 13% for patients with bacterial meningitis and early seizures, and 2.4% for patients with bacterial meningitis without early seizures. The 20-year risk of 2.1% for patients with aseptic meningitis was not increased over the general population incidence of unprovoked seizures.
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PMID:The risk of unprovoked seizures after encephalitis and meningitis. 341 88

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.
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PMID:Cerebral infarction in Hemophilus influenzae type B meningitis. 348 26


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