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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-three infants with clinically proven bacterial meningitis were studied with real-time cranial sonography at the time of initial diagnosis and in several cases subsequently. A spectrum of sonographic abnormalities was observed, including bright convolutional markings, focal or diffuse increased and/or decreased parenchymal echoes, ventricular debris, and hydrocephalus. In three infants with virulent Gram-negative meningitis serial sonographic studies showed the development of encephalomalacia. Because clinical neurologic assessment of the infant is limited, a diagnostic imaging method that is sensitive to early structural change and suitable for serial observations is advantageous. Transfontanelle real-time sonographic examination of the brain was found to be a reliable, informative, and relatively inexpensive method of documenting and monitoring complicated bacterial meningitis.
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PMID:Bacterial meningitis in infants: sonographic features. 641 Aug 62

The value of C reactive protein measurement in the differential diagnosis of meningitis was assessed in a population where tuberculous meningitis is prevalent. C reactive protein was measured serially with a sensitive radioimmunoassay in sera from 31 children with bacterial meningitis, 15 with tuberculous meningitis (6 with miliary tuberculosis), and 28 with viral meningitis. Concentrations of C reactive protein in patients with tuberculous meningitis lay between those of patients with bacterial and viral meningitis--a finding which detracts from the virtually absolute discrimination C reactive protein measurement allows between bacterial and viral meningitis. In all but two of the patients with tuberculous meningitis, C reactive protein concentrations fell rapidly after treatment began and became normal after 10 days. This fall did not, however, exclude the development of hydrocephalus as a complication. Measurement of C reactive protein remains a useful additional parameter in the diagnosis and management of the various types of meningitis.
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PMID:Value of C reactive protein measurement in tuberculous, bacterial, and viral meningitis. 646 35

Cerebral abscess is rare in children under 6 months of age but is associated with high mortality and morbidity. We report the 12 cases admitted to this hospital in the past 20 years and review the published reports on cerebral abscess in infancy and childhood. Although mortality associated with cerebral abscess in infancy has improved, morbidity is still high. We recommend that all infants aged under 6 months presenting with bacterial meningitis have a computed tomogram or ultrasound examination to exclude cerebral abscess and hydrocephalus.
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PMID:Cerebral abscess in the under 6 month age group. 665 28

Glutamic acid decarboxylase (GAD) activity in cerebrospinal fluid (CSF) was determined in 53 patients with neurological diseases as follows: Epilepsy (n:17), febrile convulsions (n:3), meningoencephalitis (n:17), encephalopathies (n:10), CNS leukemia (n:3), congenital hydrocephalus (n:2) and pseudoileus neonatorum (n:1). Compared with the mean normal value (5.2 +/- 2.5 pmol CO2 formed/hr/ml) reported in Part I, a significant increase of GAD activity in CSF was demonstrated in patients with uncontrolled epileptic seizures (11.4 +/- 3.9 pmol CO2 formed/hr/ml), febrile convulsions (13.5 +/- 8.7), viral meningitis with or without encephalitis (20.3 +/- 13.6), encephalopathies (30.0 +/- 25.9), CNS leukemia (11.1 +/- 5.0), congenital hydrocephalus (20.5 +/- 7.3) and pseudoileus neonatorum (28.6). Markedly high GAD activity was found in patients with CNS leukemia several days after intrathecal injection of methotrexate (39.8 +/- 18.0). On the other hand, significantly low GAD activity was shown in patients with bacterial meningitis or brain abscess (1.3 +/- 1.2). This suggests that some bacterial factors may be inhibitory toward GAD activity in CSF. High GAD activity in CSF may be useful as an indicator of aseptic brain dysfunction, although it was not always correlated with the severity of symptoms.
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PMID:Glutamic acid decarboxylase in cerebrospinal fluid in infancy and childhood Part II. Glutamic acid decarboxylase activity in cerebrospinal fluid of children with neurological diseases. 666 Apr 21

Five infants with meningitis and ventriculitis, and a sixth patient with meningitis only are reported. In one hydrocephalic infant, infection of the central nervous system (CNS) was not suspected until cerebral ultrasonography revealed features of ventriculitis. It appears that in non-communicating hydrocephalus managed with a ventriculo-peritoneal (VP) shunt, infection may involve predominantly the "sequestered ventricles" rather than the spinal meninges. In four infants, bacterial meningitis had been proven but ventriculitis was not diagnosed until cerebral ultrasonography was performed. In a sixth neonate, E coli Kl meningitis was diagnosed and treated very early and cerebral ultrasonography showed involvement of the surface of the brain, but not the ventricles. The ultrasonographic features of bacterial ventriculitis and meningitis in infancy are: Increased echogenicity of the ventricular fluid, either in a fine homogeneous pattern, or with strand-like material and coarse particles. Increased echogenicity of the ependymal lining of the ventricles. Loss of definition of the surface of the choroid plexuses. Hydrocephalus, which may be progressive, with or without loculation of fluid. Abnormally wide and prominent cerebral sulci as a sign of meningitis. With treatment, the ventricular fluid became normal in a few days. The other abnormalities resolved more slowly. Hydrocephalus and fluid loculation were slowest to resolve. Ultrasonography has the potential for recognition of other complications such as subdural fluid collections and cerebral abscess.
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PMID:The ultrasonographic diagnosis of bacterial meningitis and ventriculitis in infancy: six case reports. 672 68

Auditory brainstem response (ABR) was used to assess possible brainstem damage in 60 patients recovering from bacterial meningitis. Clear evidence of brainstem abnormalities was evident in 10% of the patients tested. Another 15% had ABRs classified as borderline normal. We evaluated various clinical and demographic factors to determine their predictive value with regard to neurologic abnormalities. Brainstem involvement was most likely when meningitis was complicated by seizures, hydrocephalus, nerve palsies (not including the eighth nerve), and a hemoglobin level of less than 11 g/dL, and when pretreatment symptoms persisted for longer than three days. Instances of partial and complete reversibility of brainstem damage were documented, indicating that reorganization of brainstem structures persisted after patients were discharged from the hospital.
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PMID:Auditory brainstem response in infants recovering from bacterial meningitis. Neurologic assessment. 687 Jun 11

Of 102 patients with bacterial meningitis admitted to the Children's Hospital of Buenos Aires, 25 were selected for computed tomographic (CT) scans on the basis of altered consciousness for more than 96 hours after admission, persistent or recurrent seizures after 72 hours of antibiotic therapy, development of focal neurologic signs, increased intracranial pressure or prolonged fever. Scan findings included hydrocephalus, cerebritis, vasculitis, subdural effusion, cerebral atrophy, abscess, and ependymitis. Serial CT scans demonstrated the progression or regression of some complications. The CT scan was very useful in indicating the need for neurosurgical procedures.
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PMID:Computed tomography in purulent meningitis. 697 22

Acute bacterial meningitis may be associated with increased intracranial pressure, neurological sequelae such as communicating hydrocephalus, and a slow response to antibiotic therapy. Alterations in cerebrospinal hydrodynamics are at least partially responsible for these complications. Constant, low-flow short-duration manometric infusion studies through a hollow-bore pressure monitoring device in direct continuity with the supracortical subarachnoid space were performed in rabbits with experimental meningitis. Maximal resistance to cerebrospinal fluid (CSF) outflow from the subarachnoid to vascular space was markedly increaed in acute pneumococcal meningitis when compared to control, uninfected animals (6.77 +/- 3.52 vs. 0.26 +/- 0.04 mm Hg/microliter per min, P less than 0.001). Similar elevations (8.93 +/- 4.15 mm Hg/microliter per min were found in experimental Escherichia coli meningitis. Despite eradication of viable bacteria from the CSF by penicillin therapy during the acute stage of pneumococcal meningitis, resistance remained elevated (6.07 +/- 4.68 mm Hg/microliter per min) and had not returned to normal up to 15 d later. Administration of methylprednisolone during the early stages of acute pneumococcal meningitis reduced mean peak outflow resistance towards control values (0.59 mm Hg/microliter per min) and no "rebound" effect was apparent 24 h later. These hydrodynamic alterations in experimental meningitis prevent normal CSF absorption and decrease the ability of the bran to compensate for changes in intracranial volume and pressure.
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PMID:Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alterations with penicillin and methylprednisolone. 699 82

The effect of ventriculomegaly with or without elevated intracranial pressure (ICP) on pulsatile flow in the anterior cerebral artery has been studied by a noninvasive Doppler technique in 11 infants with hydrocephalus. The cause of hydrocephalus was intraventricular hemorrhage in nine infants, Arnold-Chiari malformation in one, and bacterial meningitis in one. The pulsatility index (PI) (inversely related to pulsatile flow) was calculated from the systolic and diastolic amplitudes of flow in the anterior cerebral artery. All 11 patients with elevated PI had marked ventriculomegaly, and all but two had raised ICP. Four patients with massive ventriculomegaly and elevated ICP had maximal PI (ie, 1.00). The finding of elevated PI with ventriculomegaly and normal ICP, observed in two patients, suggested that ventriculomegaly is a more critical factor than ICP in the pathogenesis of the impaired flow. Treatment of ventriculomegaly in seven patients resulted in a decrease in PI. Of the four untreated patients, three died and one was not available for further study. Compromised flow in the anterior cerebral artery may be a sensitive barometer of impending ischemic injury with evolving ventriculomegaly, particularly following intraventricular hemorrhage. The PI may be a valuable parameter for the study of the mechanism of brain injury and for determination of optimal timing of corrective intervention.
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PMID:Decrease in pulsatile flow in the anterior cerebral arteries in infantile hydrocephalus. 705 59

Six cases of bacterial meningitis with myeloscintigraphic evidence of medullary arachnoiditis are reported. Four patients has tuberculous meningitis, another showed severe myelopathy, and the last was suspected to have hydrocephalus. Arachnoiditis is suspected when the earliest images show a sharp decrease of tracer concentration. Scintigraphy began 2 hours after lumbar injection of Tc-99m-Polyfructosan and imaging was performed at intervals of 2, 4, and 6 hours. This method has proved easy, innoculous, reproducible, and, owing to the small amount of irradiation, studies may be repeated during and after therapy. Scintigraphy is superior to the Queckenstedt test becaise it detects partial blocks and localizes lesions.
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PMID:Bacterial meningitis complicated by spinal arachnoiditis: diagnostic contribution of Tc-99m-inulin myeloscintigraphy. 737 25


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