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PubMed1993

Diseases of the intracranial meninges: MR imaging features.

Although the meninges are often thought of simplistically as a connective tissue sac that contains the CSF and the contents of the CNS, they are far more complex. Anatomically, they comprise several layers. Pathologically, numerous disease processes may affect the meninges; different processes may even involve different areas of the meninges. These factors all influence the MR imaging characteristics of meningeal lesions. This review briefly discusses the anatomy of the meninges, the MR imaging technique when meningeal disease is suspected, and the appearance of the normal meninges. It then focuses on tumors, infections, cysts, and other lesions that primarily involve the meninges, excluding lesions that secondarily involve the meninges.

Arachnoid Cysts↗
PubMed1994

Cerebrospinal fluid interleukin-1 beta/interleukin-1 receptor antagonist balance and tumor necrosis factor-alpha concentrations in tuberculous, viral and acute bacterial meningitis.

The levels of interleukin-1 beta, IL-1 receptor antagonist and tumor necrosis factor-alpha (TNF-alpha) were analyzed in 19 cases of tuberculous, 14 cases of viral, and 22 cases of acute bacterial meningitis, and in 18 control subjects. 20 patients (91%) with acute bacterial and 8 (42%) with tuberculous meningitis had detectable amounts of TNF-alpha in the initial cerebrospinal fluid (CSF) sample (mean 1044 +/- 131 pg/ml, range 95-1950, and mean 61 +/- 23 pg/ml, range 25-300, respectively), whereas TNF-alpha was not detectable in any of the patients with viral meningitis, or in any of the control subjects. IL-1 beta levels were 767 +/- 110 pg/ml (185-2000) in acute bacterial, 345 +/- 63 pg/ml (50-670) in tuberculous, 257 +/- 70 pg/ml (20-700) in viral meningitis, and 37 +/- 4 pg/ml (10-68) in control subjects. Il-1 receptor antagonist concentrations were significantly elevated in all meningitis groups, without significant differences between the groups. Il-1 receptor antagonist levels were 2487 +/- 62 pg/ml (2250-2950) in acute bacterial, 2216 +/- 82 pg/ml (1350-2550) in tuberculous and 1985 +/- 92 pg/ml (650-2500) in viral meningitis, and 154 +/- 26 pg/ml (20-245) in control CSF samples. A positive correlation was found between TNF and IL-1 beta levels (p < 0.01), and TNF levels and conscious state (p < 0.05). The ratio of concentrations of IL-1 receptor antagonist to IL-1 beta was 3.2 in acute bacterial meningitis, 6.9 in tuberculous meningitis and 8.3 in viral meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

[Purulent meningitis in children. II. Treatment and prognosis].

In the years 1970 to 1979 312 patients with purulent meningitis were treated at the University of Innsbruck, Department of Pediatrics. The overall fatality rate was 16%, the majority of fatal cases were due to gram negative organisms before 1977. The mortality rate of meningococcal meningitis due to H. influenzae was 5.6 and 1.6%, respectively and compares very well to reports in the literature. 12% of children are severely handicapped. Hearing impairment is the most frequent cause of retardation with 6.8%. We compared therapeutic results of two different treatment regimen in our clinic with the therapeutic results in other centers reported in the literature. The combination of ampicillin and chloramphenicol was superior to other treatment modalities particularly ampicillin monotherapy in H. influenzae meningitis and meningitis due to unknown organisms. Theoretical reservations against this combination have been eliminated by the proof of the bactericidal action of chloramphenicol against the most common meningeal pathogens and the synergistic action with beta lactam antibiotics. In pneumococcal meningitis the administration of high doses of Na-Penicillin G as i. v. bolus proved to be connected with unexpected complications and fatalities. The administration of 25000-40000 E Na Penicillin G as an i. v. infusion over 1 hour 4--6 times daily was a less hazardous yet effective therapy. Unsatisfying results in the treatment of gram negative meningitis in neonates prompted the investigation of a new compound fosfomycin for this indication. In vitro investigation of the antimicrobial activity against 68 meningeal pathogens and investigation of this drug in a lapine model showed encouraging results. In the last years a limited clinical trial in severely affected newborn infants was done with promising therapeutic efficacy. A larger scale investigation of this drug is now proceeding in form of a National cooperative Study of gram negative meningitis in Austria. Besides an effective antimicrobial treatment particular attention has to be paid to an adequate fluid and electrolyte replacement. Symptomatic therapy of complications e. g. seizures as well as continuous close monitoring of all vital signs is mandatory for optimal therapeutic success. Subdural effusions have been observed infrequently and only diagnostic subdural punctures have been performed.

Ampicillin↗
PubMedDate not supplied

Tumor necrosis factor-alpha and interleukin-1 beta levels in children with bacterial, tuberculous and aseptic meningitis.

Cerebrospinal fluid levels of tumor necrosis factor-alpha and interleukin-1 beta in 78 children with nonbacterial, bacterial and tuberculous meningitis, and in 34 control subjects were analyzed in order to evaluate the involvement of these cytokines in the pathogenesis of acute bacterial meningitis and their discriminative value between different etiologies of meningitis. Tumor necrosis factor-alpha and interleukin-1 beta levels were significantly higher in bacterial and tuberculous meningitis than in aseptic meningitis and in control subjects (p < 0.0001). There was no difference in the levels of tumor necrosis factor-alpha and interleukin-1 beta between nonbacterial meningitis and control groups. The finding that both tumor necrosis factor-alpha and interleukin-1 beta are increased in the cerebrospinal fluid of patients with bacterial and tuberculous meningitis whereas normal levels of these two cytokines have been found in patients with nonbacterial meningitis signifies that these cytokines may be used to differentiate between bacterial and nonbacterial meningitis.

Acute Disease↗
PubMedDate not supplied

Inappropriate antidiuretic hormone in children with viral meningitis.

Urinary excretion rates of antidiuretic hormone were determined by radioimmunoassay in children with bacterial (6) and viral (11) meningitis, and in children with other febrile illnesses (7). These values were compared to normal data obtained from 50 healthy, normally hydrated children ranging in age from 1 week to 9 years. Plasma sodium concentrations were measured in the sick children; urine osmolality and creatinine concentrations were measured in all children. Upon admission, all children with bacterial meningitis and 64% of those with viral meningitis had urinary antidiuretic hormone excretion rates greater than 2 S.D. above values obtained from age-matched controls. Fifty-seven percent of children with other febrile illnesses had similarly elevated antidiuretic hormone values; however, only in the bacterial and viral meningitis groups were antidiuretic hormone excretion rates inappropriate because they occurred when serum sodium concentrations were found to be normal or low normal (i.e., 136 +/- 2 mEq/L and 137 +/- 1 mEq/L, respectively). The average serum sodium in the group with other febrile illnesses was higher (146 +/- 5 mEq/L; p less than 0.05) and could represent an appropriate stimulus for antidiuretic hormone release. In spite of high levels of antidiuretic hormone, most viral meningitis patients did not concentrate their urine, probably because all except 2 were younger than 2 months of age. We conclude that viral meningitis, like bacterial meningitis, frequently is associated with inappropriate antidiuretic hormone secretion; however, most children with viral meningitis may be protected from developing hyponatremia because of their inability to concentrate their urine.

Child↗
PubMed1986

Paediatric meningitis in the western Cape. A 3-year hospital-based prospective survey.

Between July 1981 and June 1984 1223 cases of meningitis were seen in the Department of Paediatrics, Tygerberg Hospital. The commonest form in each population group was aseptic meningitis. Positive viral cultures were obtained from the CSF in 108 cases. The median age of white children with aseptic meningitis, 64 months, was significantly greater than that of coloured children, 45 months (P greater than 0.0001), and black children, 26 months (P greater than 0.014). The commonest cause of confirmed bacterial meningitis was Neisseria meningitidis (140 cases; 11.5%), which continues to affect mainly young coloured children (median age 16.9 months). Resistance to sulphonamides was found among 21% of 114 N. meningitidis isolates. Among white children Haemophilus influenzae was responsible for 9 of the 18 cases of confirmed bacterial meningitis. Tuberculosis was responsible for 62 cases of meningitis (5%) and was a commoner cause of meningitis than either H. influenzae (47 cases) or Streptococcus pneumoniae (34 cases). Thirty-four confirmed cases of bacterial meningitis were seen in children less than 1 month old. Klebsiella species were responsible for 8 cases (24%), Escherichia coli for 6 cases (12%), group B beta-haemolytic Streptococcus for 5 cases (15%) while 4 cases each were due to N. meningitidis and Strept. pneumoniae.

Black or African American↗
PubMed2004

The contribution of MRI to the diagnosis of diffuse meningeal lesions.

We analysed MRI findings in patients in whom a diffuse abnormality of the meninges was revealed by MRI. We looked at T1 and T2-weighted spin-echo or fast spin-echo images and contrast-enhanced T1-weighted images. There were 15 patients with abnormalities on MRI, clinically suspected in ten. Four had meningoencephalitis, one meningeal and subcortical sarcoidosis nodules, four meningeal malignancies--one disseminated oligodendroglioma, one with meningeal infiltration around an adenocarcinoma, three meningeal infiltration by a haematological malignancy, and one a chronic subdural haematoma without a history of injury. We excluded patients with primary meningeal tumours and typical injury-related meningeal bleeding. The relatively small number of patients is due to both the infrequency of diffuse meningeal disease and to the low frequency of suspected meningeal pathology as an indication for MRI. The latter's diagnostic contribution is greatest in infectious disease and neoplastic infiltration, and less obvious in haematological malignancies. Contrast-enhanced T1-weighted images are most useful.

Adenocarcinoma↗
PubMed1997

Level of transforming growth factor beta 1 is elevated in cerebrospinal fluid of children with acute bacterial meningitis.

We investigated the levels of transforming growth factor beta 1 (TGF-beta 1) in cerebrospinal fluid (CSF) in children with meningitis, with a view to prognostic relevance. CSF TGF-beta 1 levels on admission were measured by a sandwich enzyme immunoassay in children with bacterial meningitis (n = 16), aseptic meningitis (n = 12), and control subjects without evidence of central nervous system (CNS) infection (n = 16). Patients were followed up for a mean duration of 13 months, and neurodevelopmental sequelae was determined for those with bacterial meningitis. On admission, CSF TGF-beta 1 levels were significantly higher in children with bacterial meningitis (mean, standard error, 32.92, 2.36 pg/ml) as opposed to those with aseptic meningitis (25.26, 1.72 pg/ml) (P = 0.0155), or control subjects (20.53, 1.05 pg/ml) (P < 0.0001). The CSF TGF-beta 1 levels in children with aseptic meningitis were higher than those in the control group, but without significance (P = 0.02). No apparent correlation existed between CSF TGF-beta 1 levels and CSF protein or cell counts in patients with bacterial meningitis. No significant difference in CSF TGF-beta 1 levels was found between patients with or without major sequelae following bacterial meningitis.

Acute Disease↗
PubMed1993

Cerebrospinal fluid lactate in meningitis and meningococcaemia.

Cerebrospinal fluid (CSF) lactate values were measured in 26 children with meningitis (12 bacterial, 9 aseptic, 5 partially treated) and five children with meningococcaemia without meningitis. A reference range (0.5-3.2 mmol/l) was established from 100 control children. Amounts of lactate were significantly raised in bacterial meningitis (mean 6.5, range 4.5-10.2) compared with aseptic meningitis (mean 2.6, range 1.1-4.0) but this finding gave little practical help as the bacterial origin of the meningitis was clear from other CSF findings. High values (5.7) in a case of tuberculous meningitis (TBM) suggest that the test may be helpful when other CSF findings are inconclusive. Unless the CSF lactate is raised, the test is of minimal value in partially treated meningitis (mean 3.4, range 1.4-6.2). The previously unobserved finding of increased CSF lactate in meningococcaemia without meningitis (mean 3.9, range 3.1-5.0) supports the view that raised CSF lactate values in bacterial meningitis are not solely due to the presence of neutrophils. Literature relating to CSF lactate is reviewed.

Child↗
PubMed2004

Hepatocyte growth factor (HGF) in patients with hepatitis B and meningitis.

OBJECTIVES: The present study investigates serum hepatocyte growth factor (HGF) levels in patients with acute and chronic hepatitis B and the relation between these levels and intrahepatic inflammatory markers of the liver and fibrosis, as well as the cerebrospinal fluid (CSF) HGF levels in patients with meningitis and the relation between these levels and CSF findings. To our knowledge this is the first study regarding CSF HGF levels in tuberculous meningitis. PATIENTS AND METHODS: The study consisted of 35 patients with chronic hepatitis B (HbeAg and HBV-DNA positive), 20 with acute hepatitis B, 20 with acute bacterial meningitis and 15 having tuberculous meningitis. HGF levels in the serum and CSF samples were measured by using the ELISA method. RESULTS: The mean serum HGF levels in acute hepatitis B group were found statistically significantly higher than those in the control group and chronic hepatitis B group (p<0.0001). It was established that serum HGF levels in patients with chronic hepatitis B were significantly correlated with serum alanine aminotransferase (ALT) and HBV-DNA levels (r: 0.816, 0.951; p<0.05, respectively). Similarly, serum HGF levels of patients with chronic hepatitis B were correlated with fibrosis score and hepatic activity index of the liver histopathology (r: 0.750, 0.459; p<0.05, respectively). The mean CSF HGF levels of patients with acute bacterial meningitis and tuberculous meningitis were higher than those in the control group (p<0.05). In addition, it was observed that mean CSF HGF levels in patients suffered from tuberculous meningitis were statistically significantly higher than those in acute bacterial meningitis (p<0.05). CONCLUSIONS: We suggest that serum HGF level in patients with chronic hepatitis B might reflect viral load, necro-inflammatory activity in the liver and the degree of structural progression. Our findings have demonstrated that tuberculous meningitis cause increased HGF concentrations in CSF. It is, therefore, suggested that examination of HGF levels in CSF may provide additional information in the differential diagnosis.

Acute Disease↗
PubMed2003

Diagnostic capability of CSF ferritin in children with meningitis.

The current study was performed to determine the normal cerebrospinal fluid (CSF) ferritin level according to age and cut-off value for early diagnosis of bacterial menignitis. The subjects (N = 203) consisted of children who received the CSF examination at Department of Pediatrics in Chonnam National University Hospital between May 1996 and July 2001. The subjects were classified into four groups; non-meningitis, viral meningitis, bacterial meningitis, and bacterial meningitis suspected group. CSF ferritin of the meningitis group was significantly higher than that of the non-meningitis or viral meningitis groups. CSF ferritin had positive correlation with white blood cell (WBC) count and protein in CSF but negative correlation with CSF glucose (P < 0.01). CSF ferritin decreased progressively up to 1 year but such a tendency was not evident in patients over 1 year in age in the non-meningitis group. For early diagnosis of bacterial meningitis, 15.6 ng/mL was considered as the appropriate cut-off value of CSF ferritin (a sensitivity of 96.2% and a specificity of 96.6%).

Adolescent↗
PubMed2000

Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia.

In developing countries, endemic childhood meningitis is a severe disease caused most commonly by Streptococcus pneumoniae or Haemophilus influenzae type b (Hib). Although many studies have shown that fatality rates associated with meningitis caused by these organisms are high in developing countries, little is known about the long-term outcome of survivors. The purpose of this study was to assess the importance of disabilities following pneumococcal and Hib meningitis in The Gambia. 257 children aged 0-12 years hospitalized between 1990 and 1995 with culture-proven S. pneumoniae (n = 134) or Hib (n = 123) meningitis were included retrospectively in the study. 48% of children with pneumococcal meningitis and 27% of children with Hib meningitis died whilst in hospital. Of the 160 survivors, 89 (55%) were followed up between September 1996 and October 1997. Of the children with pneumococcal meningitis that were traced, 58% had clinical sequelae; half of them had major disabilities preventing normal adaptation to social life. 38% of survivors of Hib meningitis had clinical sequelae, a quarter of whom had major disabilities. Major handicaps found were hearing loss, mental retardation, motor abnormalities and seizures. These data show that despite treatment with effective antibiotics, pneumococcal and Hib meningitis kill many Gambian children and leave many survivors with severe sequelae. Hib vaccination is now given routinely in The Gambia; an effective pneumococcal vaccine is needed.

Child↗
PubMed1994

Complement deficiency predisposes for meningitis due to nongroupable meningococci and Neisseria-related bacteria.

Nongroupable meningococci or bacteria related to the genus Neisseria rarely cause meningitis. Complement deficiency has been identified as a major predisposing factor for meningococcal disease. To assess whether patients with meningitis due to such strains have a complement deficiency, we studied 12 persons. Six patients had meningitis due to nongroupable strains of meningococci, and six patients had meningitis due to Moraxella species or Acinetobacter species. Inherited complement component C7 or C8 deficiency was found in two persons who had had meningitis due to nongroupable meningococci, and one C8-deficient person had had meningitis caused by Moraxella osloensis. Hypocomplementemia resulting from CSF drain-associated shunt nephritis was found in one person with meningitis due to Moraxella nonliquefaciens and in one person with meningitis due to Acinetobacter lwoffi. This rather high frequency of inherited or acquired complement deficiencies among patients with meningitis due to nongroupable meningococci, Moraxella species, and Acinetobacter species justifies the recommendation that such patients must be studied for complement deficiency.

Acinetobacter Infections↗
PubMed1992

Toxicity in neuronal cells caused by cerebrospinal fluid from pneumococcal and gram-negative meningitis.

To identify neurotoxic factors in meningitis, a neuronal cell line (HN33.1) was exposed to cerebrospinal fluid (CSF) obtained from rabbits with pneumococcal meningitis or Escherichia coli meningitis or 2 h and 6 h after meningitis was induced by proinflammatory bacterial products (pneumococcal cell walls, endotoxin). CSF from all types of meningitis induced similar degrees of cytotoxicity. When a soluble tumor necrosis factor (TNF) receptor that completely blocked TNF-mediated toxicity at 10(-7) M was used, all toxicity in meningitis caused by E. coli, endotoxin, or pneumococcal cell wall administration (2 h afterwards) was mediated by TNF. In contrast, CSF from animals with meningitis caused by live pneumococci or pneumococcal cell wall injection (6 h afterwards) retained cytotoxicity in the presence of the TNF receptor. Thus, in established pneumococcal meningitis, but not in the other forms of meningitis, TNF is not the only component toxic in this neuronal cell line.

Animals↗
PubMed1999

Meningitis in pediatric cancer patients: a review of forty cases from a single institution.

BACKGROUND: Although the clinical features of bacterial meningitis in adult cancer patients and in healthy children have been described, no previous large series has described the clinical features of meningitis in pediatric cancer patients. We performed a retrospective review of bacterial or fungal meningitis in pediatric cancer patients to determine its clinical presentation, microbiology and outcome. METHOD: We reviewed the medical records of all patients younger than 18 years old with a diagnoses of any malignancy and bacterial or fungal meningitis at Children's Hospital and Regional Medical Center in Seattle, WA, from January, 1981, to June, 1998. RESULTS: During the study period there were 40 cases of bacterial or fungal meningitis in 36 pediatric cancer patients. Most patients (65%) had recent neurosurgery, a central nervous system device or cerebrospinal fluid leak. Neutropenia was present in 30% of patients. Fever and altered mental status were the most consistent signs at presentation. In addition at least one additional symptom or sign of meningitis (headache, neck pain or rigidity, seizures or photophobia) was present in 77% of cases. Staphylococcus aureus and Streptococcus pneumoniae were the most common microbiologic isolates. The five patients with fatal outcome were neutropenic. Neutropenia and seizures within 2 days of presentation were associated with long neurologic sequelae. CONCLUSIONS: Meningitis in pediatric cancer patients was associated with significant morbidity and mortality. Pediatric cancer patients with meningitis had clinical features and microbiology distinctly different from those of adult cancer patients and normal children with meningitis.

Adolescent↗
PubMed2005

Role of tumor necrosis factor-alpha in sensorineural hearing loss after bacterial meningitis.

HYPOTHESIS: Blockade of tumor necrosis factor-alpha with tumor necrosis factor-alpha antibody will reduce the extent of cochlear injury and hearing loss associated with Streptococcus pneumoniae meningitis. BACKGROUND: Inflammatory mediators play a significant role in the morbidity associated with bacterial meningitis, including hearing loss and labyrinthitis ossificans. Previous studies have shown the attenuation of hearing loss by the nonspecific blockade of such pathways. METHODS: Fifty Mongolian gerbils were divided into four groups. Auditory brainstem response testing was conducted to measure hearing thresholds. Streptococcus pneumoniae meningitis was induced in Groups 1 and 2. Group 2 was then given a single intraperitoneal injection of tumor necrosis factor-alpha antibody, whereas Group 1 received phosphate-buffered saline. Uninfected animals in Groups 3 and 4 were implanted with osmotic pumps that delivered a continuous 8-day intrathecal flow of either tumor necrosis factor-alpha (Group 4) or phosphate-buffered saline (Group 3). After 6 weeks, auditory brainstem response testing was repeated. The cochleas were harvested and analyzed histomorphometrically. RESULTS: Group 2 animals with Streptococcus pneumoniae meningitis that also received tumor necrosis factor-alpha antibody developed significantly less hearing loss than Group 1 animals with meningitis alone. The decrease in the average threshold at 4, 8, 16, and 32 kHz was 31, 30, 25, and 28 dB sound pressure level, respectively (p < 0.0092 for each). Furthermore, histomorphometric analysis showed significantly less damage to the organ of Corti, spiral ganglion, spiral ligament, and stria vascularis in Group 2. Conversely, tumor necrosis factor-alpha induced meningitis animals (Group 3) showed increased hearing loss compared with phosphate-buffered saline controls (Group 4), with p < 0.0001 at all frequencies. CONCLUSION: Tumor necrosis factor-alpha plays an important role in cochlear injury after bacterial meningitis. Blockade of tumor necrosis factor-alpha reduces postmeningitic hearing loss and cochlear injury. Induction of meningitis with intrathecal tumor necrosis factor-alpha also resulted in hearing loss and cochlear injury similar to bacterial meningitis.

Animals↗
PubMed1994

Lumbar punctures in suspected bacterial meningitis: too many or too few?

Children aged 1 month to 14 years admitted to the Royal Alexandria Hospital for Children during a 10 month period with suspected meningitis were studied prospectively. The aims were to determine how often lumbar puncture (LP) was delayed or never done, in relation to the outcome of all children, in order to determine the risks of LP and the risks of not doing LP. Of 218 children with suspected meningitis, LP was performed immediately in 195 (89.4%). Meningitis was diagnosed in 49 of these (bacterial 18, viral 31). No child developed cerebral herniation due to immediate LP. There were 11 traumatic taps and two children required repeated attempts. Lumbar puncture was delayed, but performed at a later time in 17 children, of whom three had proven bacterial meningitis, 1 had presumed bacterial meningitis but no organism was detected and 13 had alternative diagnoses. Six children never had an LP, although ventricular cerebrospinal fluid was obtained from two. Four of these six children had presumptive bacterial meningitis, one had tuberculous meningitis presenting with acute hydrocephalus and diagnosed post-mortem, and one had a very poor neurological outcome and no final diagnosis was reached. Of the 27 children with bacterial meningitis, LP was performed immediately in 18, or two-thirds. There were only minor adverse effects of immediate LP. Delayed LP probably resulted in failure to identify the organism in one child with bacterial meningitis, but did not adversely affect outcome in any child. Of the six children in whom LP was never performed, in only one was no final diagnosis reached.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Rapid diagnosis of gram-negative bacterial meningitis by the Limulus endotoxin assay.

The Limulus amoebocyte lysate endotoxin assay was evaluated as a method for rapid diagnosis of acute bacterial meningitis in a series of 305 patients. The results of Limulus assays on cerebrospinal fluid (CSF) samples from these patients were compared with the results for each patient of routine bacterial cultures and Gram stains. Positive Limulus tests were obtained on initial CSF specimens from 84% of patients with culture-proven bacterial meningitis, including all patients with meningitis due to gram-negative organisms. Initial Gram-stained smears revealed the presence of organisms in 68% of the patients. One patient with pneumococcal meningitis had a weakly positive Limulus assay, whereas patients with meningitis due to other gram-positive organisms, those with aseptic meningitis, or patients without meningitis had negative CSF Limulus tests. The Limulus assay also demonstrated the persistence of endotoxin in the CSF of certain patients during antibiotic therapy, especially patients with Haemophilus influenzae meningitis. The Limulus test proved to be a rapid, reliable indicator of the presence of gram-negative organisms in the CSF of patients suspected of acute bacterial meningitis.

Adult↗