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Cerebral herniation in pyogenic meningitis: prevalence and related dilemmas in emergency room populations in

G O Akpede1, J P Ambe

  • 1Neurology and Infectious Diseases Unit, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.

Developmental Medicine and Child Neurology
|September 6, 2000
PubMed

Insights

Cerebral herniation in children with meningitis is linked to poor outcomes, especially when it occurs before or after lumbar puncture (LP). Selective LP policies may improve survival rates in developing countries.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Tropical Medicine

Background:

  • Pyogenic meningitis poses a significant threat to children in tropical regions.
  • Cerebral herniation is a critical complication of meningitis with high mortality and morbidity.
  • The role of lumbar puncture (LP) in relation to herniation and outcomes in this population requires further investigation.

Purpose of the Study:

  • To determine the frequency of possible cerebral herniation in postneonatal infants and children with pyogenic meningitis.
  • To evaluate the association between cerebral herniation, lumbar puncture timing, and patient outcomes in a tropical setting.

Main Methods:

  • A prospective study involving 123 children (6 weeks to 15 years) with pyogenic meningitis over 3.5 years in Nigeria.
  • Clinical evaluation using established scoring systems to assess herniation risk and presence.
  • Analysis of outcomes (death or neurological sequelae) in relation to herniation status and LP timing.

Main Results:

  • 15% of patients presented with evidence of herniation.
  • High-risk patients had a significantly increased relative risk (RR) of herniation (66.6) and adverse outcomes (RR 2.6).
  • Herniation occurring before or after LP was associated with significantly higher rates of death or neurological sequelae compared to no herniation.

Conclusions:

  • Patient outcomes in pyogenic meningitis are strongly influenced by illness severity and the presence and timing of cerebral herniation.
  • A selective approach to lumbar puncture, rather than routine performance, may improve outcomes for meningitis patients in resource-limited settings.

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