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PubMed2003

Spectrum of complications and mortality of bacterial meningitis: an experience from a developing country.

OBJECTIVE: The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis. METHODS: The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001. RESULTS: One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41 +/- 12.3 years. One hundred and ninety (97.9%) patients had community-acquired meningitis; only 4 (2.0%) patients developed meningitis nosocomially. The two most common predisposing factors were diabetes mellitus (13.9%) and otitis media (7.7%) among all 194 patients. A significant proportion of patients with complications had diabetes mellitus (24.6%, p < 0.001). CSF and blood cultures were positive in 53 (27.3%) and 42 (21.6%) patients respectively; there was no statistical difference found. The most common organisms isolated were Streptococcus pneumoniae in 35 (36.8%) patients followed by Neisseria meningitides in 30 (31.5%) patients. Approximately 68% of positive cultures yielded S. pneumoniae and N. meningitides (p < 0.0001). The overall mortality rate was 22.1%. The mortality rate for Streptococcus pneumoniae was 17.1%. The highest mortality was observed in patients with Pseudomonal meningitis where all four patients expired followed by mortality rate of 85.7% in Escherichia coli afflicted patients (p < 0.001). Complications occurred in 73 (37.6%) patients with persistent complications in 31 (42.4%) patients. Complications resolved in 34 (46.5%) patients. The most common complications were seizures (12.8%) and cranial nerve palsies (11.3%). Seizures were more likely to occur in older patients (p < 0.05) whereas hydrocephalus was more common in younger patients (p < 0.05). CONCLUSION: Bacterial Meningitis remains a serious disease associated with substantial morbidity and mortality. Most cases are community acquired with S. Pneumoniae being the most common pathogen. Old age, diabetes mellitus, a positive culture, seizures as a complication and late stage in the disease are the important predictors of a poor outcome.

Adult↗
PubMed1992

Occurrence of multiple antimicrobial resistance among Haemophilus influenzae type b causing meningitis.

Among the 157 children with culture proven pyogenic meningitis who were admitted during 1987-1991, in the Department of Child Health at the Christian Medical College and Hospital, Vellore, 40 had H. influenzae type b (HIB) meningitis; 17 of these had multiantimicrobial resistant HIB (MRHIB) and 23 others had usual susceptibility HIB (USHIB) meningitis. The two groups were compared. Children with MRHIB meningitis who received optimal treatment with cefotaxime had excellent recovery. When cefotaxime therapy was delayed, mortality was noted in all except one child who survived with severe neurological sequelae. MRHIB meningitis treated with drugs other than cefotaxime had 100 per cent mortality. Cefotaxime is therefore recommended in children below 3 yr of age presenting with purulent meningitis, as MRHIB is a possible causative agent in this group.

Anti-Bacterial Agents↗
PubMed2004

[Modern characteristics of clinical course and treatment of otogenic purulent meningitis].

A total of 170 patients aged 2.5 to 60 years have received treatment for otogenic meningitis caused by acute (n=37, 21.2%) or chronic otitis media (n=137, 78.2%). Otogenic meningitis ran atypically with masked clinical manifestations in 32.2% patients. It is thought justified to repeat an antibiotic injection into the cerebrospinal canal in a severe course of meningitis, especially in combination of meningitis with other forms of intracranial complications. If clinical signs of acute otitis media and meningitis manifested weakly and, therefore, otogenic nature of meningitis is questionable, it is recommended to implement an expectant treatment policy. The absence of noticeable positive shifts in the course of the disease after several days of intensive conservative treatment is an indication for surgical intervention.

Adolescent↗
PubMed2003

Sensorineural hearing loss in children with epidemic meningococcal meningitis at Tikur Anbessa Hospital.

There are several reports on epidemic meningococcal meningitis in some areas of Ethiopia, which lie in the meningococcal meningitis belt of Africa. Very little is known about the neurological sequel of epidemic meningococcal meningitis, especially that of hearing loss. This hospital-based study was conducted prospectively at the Ear Nose Throat clinic of the Pediatric Outpatient Department of the Tikur Anbessa Hospital during the meningococcal meningitis epidemic from May to October 2000 in order to assess the hearing status of patients after completion of their course of treatment. Demographic, clinical, microbiologic, audiometric data were collected using a preformed questionnaire. One hundred forty one cases of pyogenic meningitis were examined at discharge and on subsequent visits. Most of the patients (73.5%) were between 5 and 12 years of age. The major bacteriological isolate from the cerebrospinal fluid in 48 cases (35.3%) of the specimens was meningococci. Hearing loss was the commonest neurological sequel at discharge constituting 25% of the cases. At least 12.5% of the patients had severe to profound sensorineural hearing loss. This level of hearing loss would affect communication abilities and impair studies in school if left without rehabilitative measures including hearing aids or other means. Large scale community based studies are required to determine the magnitude of hearing loss associated with epidemic meningococcal meningitis.

Child↗
PubMed2004

[Haemophilus influenzae, the second cause of bacterial meningitis in children in Madagascar].

The Haemophilus influenzae b is one of the main germs causing bacterial meningitis in children in countries where the vaccine anti-Haemophilus influenzae b is not widely used. In Madagascar, no epidemiological study on this germ has been carried out. The objective of this research is to assess the role of Haemophilus influenzae meningitis in Antananarivo and to determine its epidemiological aspects and evolution. A multicentric study coordinated by the Institut Pasteur de Madagascar included all children less than 15 years old with infectious syndromes associated to a syndrome of meningial irritation and/or convulsion and/or coma. These children were admitted in the pediatric service of the three main hospitals in Antananarivo from June 1998 and June 2000. A lumbar puncture was performed on each child; the cerebrospinal fluid was set aside for cytobacterial and biochemical controls completed with an antimicrobial sensitivity testing and a soluble antigens research. Out of 160 case studies, the Haemophilus influenzae b arrives at the second place among the agents causing bacterial meningitis in children. This type of bacteria is the source of 32% of meningitis after the Streptococcus pneumoniae (34%). It affects 96% of children less than two years old, with a maximal frequency before the age of one year. The lethality rate is 28.6% and the neurological sequelae were observed in 31.4% of patients. Haemophilus influenzae is sensitive to the third generation cephalosporins but shows high resistance to chloramphenicol (42%), amoxicillin (29%) and gentamicin (22%). The relatively high frequency as well as the high lethality rate caused by the Haemophilus influenzae b meningitis, affecting selectively the children under two years old, bring in the need to introduce the anti-Haemophilus influenzae b vaccine in the national vaccination program in Madagascar. This vaccine has proved to be efficient in many countries where it has been used. Furthermore, in the probabilistic treatment of bacterial meningitis in children, the third generation cephalosporins should be used in the first place.

Adolescent↗
PubMed2004

[Outbreak of meningitis in the province of Logone occidental (Chad): descriptive study using health ministry data from 1998 to 2001].

UNLABELLED: Outbreaks of meningitis are a public health problem in sub-Saharan Africa where more than thousand cases are declared every year In Chad, the last outbreak happened between 1998 and 2001. The objective of this study is to describe epidemiologic profile of meningitis in the province of Logone Occidental from 1998 to 2001. METHODS: Study used epidemiologic data of surveillance's tools from years 1998 to 2001 in Chad. RESULTS: Data of the study indicated a two-yearly cycle with outbreaks in 1998 and 2000 occurring in endemic background during 1999 and 2001. The first cases began in January with an incidence rate close to 30 for 100.000/week. The epidemic peak occurred on the 11th week (1999-2001), on the 12th week (1998-2000) during dry season. Outbreak continued 9 weeks and stopped on the 16th week (April-May). The lethality average was 12% and reached 30% at the beginning of the outbreak. DISCUSSION: Despite vaccination campaigns during outbreaks, epidemiology did not change in Chad. Quality of epidemiological surveillance is not sufficient and political reaction is too slow. Moreover, human, material and financial deficiency add to these difficulties. Integrated vaccination against meningitis into the immunization preventive program was evocated but would not permit enough collective immunity. Biotope changes generated by human activity could contribute to perpetuating outbreaks. New outbreak of W135 meningitis in Burkina Faso (2002) may change the epidemiological profile of the meningitis in sub-Saharan Africa. CONCLUSION: Meningitis outbreaks control using vaccination after the first cases appears to be limited, however this strategy must be evaluated in Chad to know vaccination covering, target population and protection after vaccination.

Chad↗
PubMed2005

Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences.

BACKGROUND AND PURPOSE: Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MR imaging. The purpose of this study was to compare contrast-enhanced T1-weighted MR images with fat suppression to contrast-enhanced FLAIR images to determine which sequence was superior for depicting meningeal disease. METHODS: We reviewed MR images of 24 patients (35 studies) with a variety of meningeal diseases. The MR imaging protocol included contrast-enhanced T1-weighted MR images with fat suppression (FS) and contrast-enhanced fluid-attenuated inversion recovery (FLAIR) images that were reviewed by three neuroradiologists and were assigned a rating of positive, equivocal, or negative for abnormal meningeal enhancement. The two sequences were compared side by side to determine which better depicted meningeal disease. RESULTS: Abnormal meningeal enhancement was positive in 35 contrast-enhanced T1-weighted MR images with FS and in 33 contrast-enhanced FLAIR studies. In the first group, which had the T1-weighted sequence acquired first (21 of 33 studies), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in 11 studies (52%), inferior contrast enhancement in six studies (29%), and equal contrast enhancement in four studies (19%) compared with the contrast-enhanced FLAIR images. In the second group, which had the FLAIR sequence acquired first (12 of 33), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in seven studies (58%), inferior contrast enhancement in two studies (17%), and equal contrast enhancement in three studies (25%). CONCLUSION: Contrast-enhanced T1-weighted MR imaging with FS is superior to contrast-enhanced FLAIR imaging in most cases for depicting intracranial meningeal diseases.

Adolescent↗
PubMed2005

Incidence of tuberculous meningitis in France, 2000: a capture-recapture analysis.

OBJECTIVE: To estimate the incidence of culture-positive and culture-negative tuberculous meningitis (TBM) in France in 2000. METHODS: Capture-recapture method using two unrelated sources of data: the tuberculosis (TB) mandatory notification system (MNTB), recording patients treated by anti-tuberculosis drugs, and a survey by the National Reference Centre (NRC) for mycobacterial drug resistance, recording culture-positive TBM. RESULTS: Of 112 cases of TBM reported to the MNTB, 28 culture-positive and 34 culture-negative meningitis cases were validated (17 duplicates, 3 cases from outside France, 21 false notifications, and 9 lost records were excluded). The NRC recorded 31 culture-positive cases, including 21 known by the MNTB. When the capture-recapture method was applied to the reported culture-positive meningitis cases, the estimated number of meningitis cases was 41 and the incidence was 0.7 cases per million. Sensitivity was 75.6% for the NRC, 68.3% for the MNTB, and 92.7% for both systems together. When sensitivity of the MNTB for culture-positive cases was applied to culture-negative meningitis, the total estimated number of culture-negative meningitis cases was 50 and the incidence was 0.85 cases per million. CONCLUSION: TBM is underestimated in France. Capture-recapture analysis using different sources to better estimate its incidence is of great interest.

Adult↗
PubMed2005

Diagnostic approach to recurrent bacterial meningitis in children.

Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization and multiple invasive investigations if the underlying cause remains undetected. Bacteria migration, along congenital or acquired pathways from the skull or spinal dural defects, gains entrance into the central nervous system (CNS) and should be taken into consideration when children face recurrent bacterial meningitis, however, symptoms and signs of cerebrospinal fluid (CSF) rhinorrhea or otorrhea are rare in such patients. Without evidence of CSF leakage, a cranial symptom/sign or coccygeal cutaneous stigmata may suggest the approximate lesion site, diagnosis and detection remains difficult. To detect an occult dural lesion along the craniospinal axis, such as basal encephalocele, dermal sinus tract, or neurenteric cyst, a detailed clinical evaluation and the use of the modern diagnostic imaging methods is necessary. Because of the possibility of concomitant occurrence of more than one malformation, both the frontal and the lateral skull base should be carefully evaluated. Precise localization of the dural lesion is a prerequisite for successful surgical repair. In addition, the bacteria specificity could leave significant clues: Pneumoccocus or Hemophilus suggests cranial dural defects, E. coli or other gram negative bacilli suggests spinal dural defects, and meningococci suggest immunologic deficiency. Asplenia or immunodeficiency such as complement or immunoglobulin deficiency rarely causes recurrent meningitis without a history of frequent infection of non-CNS areas. Salmonella meningitis or brain abscess should not be treated incompletely or inadequately and could lead to recrudescence, relapse or recurrence of bacterial meningitis. Antibiotic (penicillin or trimethoprim-sulfamethoxazole) induced meningitis may repetitively occur on occasion.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2005

[Early predictors of neurodevelopmental outcome of neonatal bacterial meningitis].

154 patients, who were hospitalized in M. Iashvili Children's central hospital in 1998-2005 were investigated. In 70 cases the diagnosis was neonatal bacterial meningitis, in 62 cases -- bacterial sepsis and neonatal meningitis and 22 cases patients were in control group with the diagnosis of neonatal bacterial sepsis. From base investigation group -132 patients were divided in two group, in which patients were united by the starting point of disease from the birth: first group included newborns with signs of disease on earlier stage (sings of the disease showed up during 24-72 hours from the birth); second group included newborns with later signs of disease (after 72 hours from the birth). Our conclusion is- outcome of bacterial meningitis depends on the starting point of disease. Meningitis which began earlier than 72 hours of life, characterized by severe prognosis. Mother's chronic infection diseases and brain injury of newborn are predictors of severe complications of neonatal bacterial meningitis. Such complications of bacterial meningitis as are: brain abscess, ventriculitis, neonatal seizures, coma and neutropenia, become predictors of severe latest outcome.

Coma↗
PubMed2005

[Correlation between rainfall and meningococcal meningitis in Niger].

The term "meningitis belt" was coined by Lapeyssonnie in 1963 to describe a zone in Africa where epidemic meningitis occurs sporadically during the dry season. The purpose of this study was to evaluate the relationship between the recorded rainfall and reported incidence of meningococcal meningitis in Niger from 1996 to 2002. A total of 58 277 cases of meningococcal meningitis were reported in Niger during the study period. The mean annual incidence was 82.2 per 10(5) inhabitants. Two epidemic years occurred during the study period, i.e., 1996 with 183 cases per 105 inhabitants and 2000 with 140 cases per 10(5). The incidence increased during the dry season and decreased at the beginning of the rainy season. Calculation of the correlation coefficient between rainfall and incidence of meningococcal meningitis showed a statistically significant negative correlation (r = -0.27; P = 0.01). Neisseria meningitidis sero-group A was predominant but strains of Neisseria meningitidis sero-group W135 have been found in specimens collected since 2002. Outbreaks of meningococcal meningitis epidemics are multi-factorial. Multivariate analysis of all factors would allow implementation of preventive measures earlier than the epidemic prediction strategy based on threshold rates proposed by the World Health Organization.

Humans↗
PubMed2006

[W135 meningococcus meningitis: study of 148 cases observed in 2002 and 2003 at the National Teaching Hospital of Ouagadougou, Burkina Faso].

The purpose of this report is to describe the bacteriological features, clinical signs and therapeutic outcome of 148 cases of W135 meningococcus meningitis observed during meningitis outbreaks in Burkina Faso in 2002 and 2003. Diagnosis was based on microbiological study of cerebrospinal fluid. Cases of meningococcus meningitis were recorded throughout the study period with the peak number of cases occurring around the 14th week. There was a slight male predominance (56.1%) and young patients between one and 15 years accounted for 81.7% of cases. The mean interval between onset of symptoms and hospitalization was 2.6 days and the mean duration of hospitalization was 5.5 days. The most common clinical signs were fever (98.6%), stiff neck (90.5%),Brudzinski's sign (85.1%),Kernig's sign (66.2%), altered consciousness (41.9%), vomiting (36.5%) and headaches (34.5%). In most cases treatment with a singie dose of chiorazuphenicol in oil was curative. Overall mortality was 15.5% idth no correlation with sex or age. Seventeen of the 23 deaths occurred within 24 hours after their admission to the hospital. The other six deaths occurred on the second day after admission inS cases and fifth day in one case. Convulsions, shock and altered consciousness were consistent poor prognostic signs. A correlation was found between mortality and interval for hospitalization with better survival in patients receiving prompt treatment. Study of the susceptibility of 102 samples showed that W135 meningococcus was sensitive to penicillin G, ampicillin,ceftriaxone and chloramphenicol but resistant to sulfamides (cotrimoxazole). Bacterial meningitis is an Important factor of morbidity and mortality worldwide. Our findings indicate that the bacteriological, clinical and epidemiological characteristics of W135 meningococcus is do not differ greatly from those of meningococcus A. Since W135 meningitis is susceptible to antibiotics used to cure meningitis, campaigns to promote early detection and treatment must be continued.

Adolescent↗
PubMed2006

[First documented case of Chryseobacterium meningosepticum meningitis in Central African Republic].

Chryseobacterium meningosepdcum is a rare but well-known causative agent of bacterial meningitis and can be the source of epidemic outbreak in neonatal facilities. It has rarely been documented in Africa. The purpose of this report is to describe the first case of C. meningosepticum meningitis in Central African Republic. The case that remained isolated occurred after dystocic delivery with resuscitation in a neonatal unit. Despite intensive care and appropriate antibiotic treatment, the newborn died on day 19. Identification of this rare cause of meningitis underlines the important role of the bacteriologic laboratory in managing bacterial meningitis in Africa. The strain of C. meningosepticum involved in this case was resistant to the main antibiotics used for first-intention treatment of neonatal bacterial meningitis, i.e., third-generation cefalosporins, chioramphenicol, and aminosides. This case also underlines the importance of familiarizing the medical staff with the dangers of nosocomial meningitis and reinforcing hospital hygiene measures.

Central African Republic↗
PubMed2006

[Antimicrobial susceptibility and serotype distribution of pneumococci strains isolated from meningitis patients].

Treatment of life threatening pneumococcal infections such as meningitis has recently become problematic due to the emergence of antibiotic resistant strains. Antimicrobial susceptibility data usually derived from the studies that included all clinical pneumococcal isolates. However, resistance patterns of this microorganism isolated from meningitis cases in our country are not exactly known. The aim of this study was to determine the antimicrobial susceptibility and serotypes of Streptococcus pneumoniae strains isolated from meningitis cases. This retrospective study was designed in three university hospitals in Turkey and 72 pneumococci isolated from patients with meningitis were evaluated. In this study disk diffusion test and E-test methods were used to determine the susceptibility of pneumococci to some antibiotics. All S. pneumoniae isolates were serotyped using Quellung reaction. Although resistance for oxacillin was found by disc diffusion method in 11 isolates, only six of them were found to be resistant by E-test. By the latter procedure, no resistance was recorded against ceftriaxone and meropenem, while chloramphenicol resistance was found as 1.4%. In our study, erythromycin, ciprofloxacin and levofloxacin resistance were 2.8%, TMP-SMX resistance was 26.4%, while no vancomycin resistance was detected by disk diffusion. In evaluation of 72 pneumococci, we found 16 different serotypes and four isolates could not be serotyped. The serogroup 23 (n: 19) was the most common one followed by serotype 19 (n: 9) and serotype 14 (n: 7). Of six resistant isolates, three pneumococci were serogroup 23 and the remaining were from three different serotype/serogroups 11, 14 and 19. As a result penicillin resistance in pneumococci isolated from meningitis was low and there was no resistance to ceftriaxone. It seems that ceftriaxone is an appropriate choice for empirical treatment of meningitis in our patients. These findings also revealed that pneumococcal polysaccharide capsule vaccines in use cover most of the invasive pneumococcal serotypes.

Adolescent↗
PubMed2006

[Meningeal carcinomatosis in patients with lung cancer].

Of the 1548 patients with primary lung cancer who were admitted to our hospital from January 2001 through March 2005, 37 in whom meningeal carciomatosis was diagnosed on cytologic examination of cerebrospinal fluid or magnetic resonance imaging of the brain and spinal cord were studied retrospectively. The most common histologic type was adenocarcinoma, diagnosed in 70% of those patients. The results of cytologic examination of cerebrospinal fluid were positive in 71%. The time from the date of diagnosis of lung cancer to the date of diagnosis of meningeal carcinomatosis ranged from -2 days to 8 years (median, 407 days). Survival from the date of diagnosis of meningeal carcinomatosis ranged from 10 to 392 days (median, 106 days). Treatment for meningeal carcinomatosis was decided on the basis of the patient's general condition and the contorol status of the primary lesion. Radiotherapy, systemic chemotherapy, and palliative therapy were combined. Gefitinib was most often used for chemotherapy after the onset of meningeal carcinomatosis, and 60% of the patients given gefitinib had stable disease. One of these patients (adenocarcinoma) survived for longer than 1 year. Further investigatons are needed to establish standard treatments, including the use of gefitinib, that can improve the quality of life and prolong the survival of patients with meningeal carcinomatosis.

Adenocarcinoma↗
PubMed1991

[Measurements of CSF biochemical tumor markers in patients with meningeal carcinomatosis].

CSF beta--glucuronidase, polyamines and carcinoembryonic antigen (CEA) were analyzed in 16 patients with meningeal carcinomatosis from solid tumors in systemic organs, 27 with benign brain lesions, 11 with primary brain tumors, 14 with metastatic brain tumors and 5 with leptomeningeal dissemination of other malignant diseases. beta--glucuronidase levels in all cases of meningeal carcinomatosis, meningeal gliomatosis and meningeal lymphoma were higher than 100 micrograms/dl/hr. On the other hand, levels in all cases of benign brain lesions were below 100 micrograms/dl/hr. Levels of beta--glucuronidase in the cases of metastatic brain tumors returned to normal levels after tumor resection. Levels of beta--glucuronidase and polyamines were not high in the cases with positive cytology in CSF after tumor resection. The polyamine level seemed to be dependent on the growth rate of the disease and was shown to below 0.05 nmol/ml in all cases after resection of the metastatic brain tumors. Cystic fluid of both benign and malignant tumor showed high levels of beta--glucuronidase and polyamines except for spermidine and spermine levels in a suprasellar cyst. Some cases of meningeal carcinomatosis with high levels of serum CEA did not always show high levels of CSF CEA. In the surgical cases with a metastatic brain tumor, the cases with leptomeningeal, especially dural attachment showed high levels of beta--glucuronidase and CEA preoperatively, but they returned to normal after surgery. In 2 cases of meningeal carcinomatosis treated by intrathecal chemotherapy with MTX and Ara-C, CSF beta--glucuronidase and CEA showed clinical condition better than the cell count in CSF decreased rapidly following chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers, Tumor↗
PubMed1991

[Meningitis and encephalitis in the years 1983-1990. Clinical observations].

From 1983 to 1990, at the I Clinic of Infectious Diseases, Silesian Academy of Medicine in Bytom, 995 patients with meningitis and encephalitis were treated; the average age was 17.86 years. After cerebrospinal fluid (CSF) examinations the patients were divided into groups. The first group consisted of patients with suppurative meningitis and encephalitis (202-20.30%), the other group were patients with aseptic meningitis (309-31.06%), a separate group consisted of patients with mumps meningitis (484-48.06% cases). In the group with suppurative meningitis and encephalitis etiological agents were isolated (Gram stain smear and/or culture of CSF) in 50.99% of cases. The most common causes of suppurative neuroinfections were: Neisseria meningitides and Streptococcus pneumoniae (in 23.76% cases). The increasing number of bacteriological tests positive results was observed during the analyzed period. The etiology of aseptic inflammation diseases of the central nervous system was defined with the help of serologic blood tests in 10-15%, and serologic confirmation of mumps meningitis was as high as 80% of cases. In the group of purulent neuroinfections, during the 8-year observation, 36 deaths occurred (17.82% of these patients). The observed tendency of the death rate decrease is concerned to be a result of better microbiological diagnostics and the possibility of an early aimed antibiotic therapy.

Adolescent↗
PubMedDate not supplied

Gadopentetate dimeglumine-enhanced MR imaging in children following surgery for brain tumor: spectrum of meningeal findings.

Gadopentetate dimeglumine-enhanced MR imaging was performed in 51 consecutive postoperative pediatric neurosurgical patients with a diagnosis of brain tumor. These studies were examined retrospectively to determine the spectrum of meningeal findings in this patient population. Patterns of enhancement were correlated with type of surgery, interval since surgery, clinical and CSF findings, and the use of radiation and steroid therapies. Normal postoperative meningeal findings include no meningeal enhancement or mild focal or diffuse dural enhancement. More moderate dural or subdural enhancement may be seen in clinically well children who have postsurgical subdural collections, or who have a remote history of serious meningeal disease (meningitis or subarachnoid hemorrhage). In all six cases in which nodular dural, leptomeningeal, or ependymal enhancement was seen, recurrent local tumor, leptomeningeal metastases, or infection were present. Leptomeningeal tumor or infection should be suspected if such patterns of enhancement are noted. Parameters that did not appear to affect the pattern of meningeal enhancement included type of surgery, interval since surgery, or therapeutic radiation.

Adolescent↗