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[Empyema and subdural effusion after meningitis. 2 cases of unusual location]
Insights
Purulent meningitis can lead to rare complications like subdural empyema in children and aseptic subdural effusions in infants, both causing increased intracranial pressure.
Area of Science:
- Neurology
- Pediatrics
- Pathology
Context:
- Purulent meningitis, a serious infection of the brain's protective membranes, can present with unusual complications.
- Subdural collections, including empyema and effusions, are potential sequelae of meningitis, particularly in infants.
Purpose:
- To report two distinct cases of subdural collections following purulent meningitis in pediatric patients.
- To highlight the varied clinical presentations and neuroradiological findings of these rare complications.
Summary:
- A 12-year-old child developed an infratentorial subdural empyema, while a 2-month-old infant presented with a large, hemorrhagic, aseptic subdural effusion, both post-meningitis.
- Both cases exhibited signs of intracranial hypertension, with diagnosis confirmed by neuroradiology, surgery, and histopathology.
- The infratentorial location of empyema and the specific posterior supratentorial location of the aseptic effusion were noted as unusual features.
Impact:
- These cases underscore the importance of considering diverse subdural pathologies as complications of purulent meningitis in children.
- Understanding these varied presentations aids in timely diagnosis and management of intracranial hypertension in pediatric patients.
- The findings contribute to the literature on rare neurological complications of meningitis, emphasizing differences in aseptic versus septic subdural collections.
Abstract:
A 12-year old child and a 2-month old infant developed, in the wane of a purulent meningitis, the former, an infratentorial subdural empyema, the latter, a large, encapsulated, haemoorhagic, aseptic subdural effusion, in the right parieto-temporo-occipital region. In both cases, signs of intracranial hypertension dominated the clinical picture. Neuroradiological investigations permitted diagnosis and localisation of the expansive processes, whose subdural position was recognized at operation and confirmed by histopathological examination. According to the literature, purulent meningitis is a rare cause of subdural empyema, except in infants; the solely infratentorial location is also unusual. Sterile subdural effusion is a more common complication of purulent meningitis in infancy, but the unilateral posterior supratentorial location is also a peculiar feature. Subdural collections after memingitis may be aseptic and possibly haemorrhagic, or septic and purulent; these different modes of presentation correspond perhaps to different degrees or stages of subdural pathological changes in the neighbourhood of leptomeningeal infection.