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Intracranial pressure in childhood central nervous system infections
P Rebaud1, J C Berthier, E Hartemann
1Unités de Réanimation Pédiatrique, Hôpital Debrousse, Hôpital Edouard Herriot, Lyon, France.
Insights
Intracranial hypertension is common in children with acute CNS infections like meningitis and encephalitis. Monitoring intracranial pressure (ICP) is crucial for predicting outcomes in severe cases, especially bacterial meningitis and herpes encephalitis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute central nervous system (CNS) infections can lead to severe neurological complications.
- Intracranial hypertension (ICH) is a significant concern in pediatric CNS infections.
- Understanding ICP dynamics is vital for managing comatose pediatric patients.
Purpose of the Study:
- To determine the significance of intracranial hypertension in pediatric patients with acute CNS infections.
- To correlate intracranial pressure (ICP) levels with clinical outcomes.
- To identify specific CNS infections where ICP monitoring is most critical.
Main Methods:
- Studied intracranial pressure (ICP) in 27 pediatric patients (45 days to 13 years) with meningitis or encephalitis.
- Patients presented with deep coma (Glasgow Coma Scale ≤ 7).
- Defined intracranial hypertension as mean ICP > 15 mmHg.
Main Results:
- ICH was observed in 86% of meningitis and 69% of encephalitis cases.
- Meningitis patients showed sudden, severe ICH.
- Survivors had lower maximal ICP and better cerebral perfusion pressure (CPP) compared to non-survivors.
- ICH occurred in all acute primary encephalitis but only 3/7 post-infectious encephalitis patients.
Conclusions:
- ICP monitoring is important in comatose pediatric patients with bacterial meningitis (early period).
- ICP monitoring is crucial for herpes encephalitis.
- ICP monitoring is indicated in post-infectious encephalitis with severe status epilepticus.
Abstract:
To determinate the importance of intracranial hypertension in central nervous system (CNS) acute infections, we studied intracranial pressure (ICP) in 27 patients, age 45 days to 13 years. Fourteen had meningitis and 13 had encephalitis; all were in deep coma with Glasgow Coma Scale 7 or less. Intracranial hypertension defined by a mean ICP above 15 mmHg, was observed in 12 patients with meningitis (86%) and in 9 with encephalitis (69%). Patients with meningitis exhibited a sudden and severe intracranial hypertension. A striking difference was noted between survivors and non survivors who had a very high maximal ICP with a severe reduction of cerebral perfusion pressure (CPP). Intracranial hypertension occurred in all patients with acute primary encephalitis but in only 3/7 patients with post-infectious encephalitis. ICP monitoring seems to be important in the comatose forms of: (1) bacterial meningitis in the early period (2) herpes encephalitis (3) post-infectious encephalitis with severe status epilepticus.