Cerebral herniation in bacterial meningitis in childhood

Among 302 infants and children with acute bacterial meningitis, the syndrome of cerebral herniation occurred in 3 of 10 fatal cases and in 15 patients who survived. The interval from time of admission to herniation was 8 hours or less, and no predictive factors could be determined. Seizures occurring immediately prior to cerebral herniation made diagnosis more difficult. Early recognition of cerebral herniation and prompt treatment with osmotic diuretics can reduce the mortality of bacterial meningitis.