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Cerebrospinal fluid pressure in pyogenic meningitis
R A Minns1, H M Engleman, H Stirling
1Department of Neurology, Royal Hospital for Sick Children, Edinburgh.
Insights
Most children with pyogenic meningitis experience elevated cerebrospinal fluid pressure. This high pressure, measured via lumbar puncture, is common and may require specific treatment to improve outcomes in pediatric meningitis.
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Pyogenic meningitis is a serious infection in infants and children.
- Cerebrospinal fluid pressure dynamics in pediatric meningitis are not fully understood.
- Clinical manifestations of meningitis can be influenced by intracranial pressure.
Purpose of the Study:
- To objectively measure cerebrospinal fluid (CSF) pressure in children with pyogenic meningitis.
- To determine the prevalence and characteristics of elevated CSF pressure in this population.
- To explore the relationship between CSF pressure and clinical presentation.
Main Methods:
- Strain gauge pressure measurement during lumbar puncture.
- Objective recording of CSF pressure in 35 infants and children.
- Analysis of pressure variations throughout the infection course.
Main Results:
- 33 out of 35 children (94%) exhibited raised CSF pressure.
- Median CSF pressure was 15 mm Hg (range 4-70 mm Hg).
- Higher median pressure (19 mm Hg) was observed on admission day.
Conclusions:
- Elevated CSF pressure is a frequent finding in childhood pyogenic meningitis.
- Clinical symptoms may be directly related to high intracranial pressure.
- Raised CSF pressure may necessitate independent treatment and impacts meningitis prognosis.
Abstract:
The pressure of cerebrospinal fluid taken at lumbar puncture was recorded objectively by strain gauge pressure measurement in 35 infants and children with pyogenic meningitis. Raised pressures were found in 33 children. The median pressure was 15 mm Hg (range 4-70 mm Hg) in all age groups. The pressure level varied throughout the infection, but a higher median pressure (19 mm Hg) was found when this was measured on the day of admission. The clinical features of the meningitis in these patients suggest that many of the presenting symptoms and signs are those of pressure. These results show that high pressure is frequently present in childhood meningitis, not just in those who die from cones or who have radiological evidence of hydrocephalus. We conclude that raised cerebrospinal fluid pressure is a frequent accompaniment of childhood meningitis and may need treatment in its own right and is therefore one further important factor influencing the course and outcome of childhood meningitis.