Computed tomography in leptomeningeal infections

Area of Science:

• Neuroradiology
• Pediatric Infectious Diseases
• Medical Imaging

Background:

• Leptomeningeal infections, primarily bacterial, pose significant risks, especially in infants and children.
• Haemophilus influenzae is a common causative agent, accounting for over half of bacterial cases.
• Early detection and monitoring of complications are crucial for effective patient management.

Purpose of the Study:

• To evaluate the utility of computed tomography (CT) in identifying complications associated with leptomeningeal infections.
• To assess the types and frequency of complications detected by CT in pediatric patients.
• To correlate specific CT findings with causative pathogens and disease progression.

Main Methods:

• Retrospective review of CT scans from 6,078 patients, identifying 47 with confirmed leptomeningeal infections.
• Patients were categorized into two groups: acute illness (Group A) and post-treatment (Group B).
• Analysis of CT findings, including brain parenchyma changes, ventricular size, and subdural effusions.

Main Results:

• CT identified 24 complications in Group A (acute illness), including diminished brain attenuation and dilated ventricles.
• Group B (post-treatment) showed 28 complications, such as enlarged ventricles, subdural effusion, and abscess formation.
• A notable 40% of patients with diminished attenuation showed frontal lobe involvement, often linked to Haemophilus influenzae meningitis.

Conclusions:

• CT scans are valuable tools for the early detection of complications in pediatric leptomeningeal infections.
• Imaging aids in evaluating the extent of lesions and identifying specific patterns, such as frontal lobe predilection.
• CT findings can guide treatment and prognostication in patients with bacterial meningitis and associated complications.