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Ischemic cerebrovascular complications of Haemophilus influenzae meningitis. The value of computed tomography
Insights
Computed tomographic (CT) scans are valuable for assessing brain involvement in children with Haemophilus influenzae meningitis. CT reliably identified ischemic cerebrovascular lesions, correlating with poor outcomes in patients with persistent deficits.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Infectious Diseases
Background:
- Severe Haemophilus influenzae meningitis can lead to significant neurological complications in children.
- Assessing cerebral involvement is crucial for prognosis and management.
Purpose of the Study:
- To evaluate the utility of computed tomographic (CT) scanning in identifying cerebral complications in children with severe Haemophilus influenzae meningitis.
- To correlate CT findings with clinical presentation and patient outcomes.
Main Methods:
- Retrospective analysis of 12 children with severe Haemophilus influenzae meningitis and focal neurologic deficits.
- Review of CT scans performed during the early hospital course.
- Correlation of CT findings with clinical course, duration of symptoms, and neurological deficits.
Main Results:
- CT scans effectively excluded brain abscess and cerebritis.
- Ischemic cerebrovascular lesions were suggested in 11 of 12 children, often appearing as low-density lesions in a vascular distribution.
- Enhancement patterns evolved over time, with gray matter or diffuse enhancement noted later in the course.
- A duration of meningitis symptoms (mean 13 days) appeared to predispose to vascular lesions.
- CT findings consistent with brain infarction predicted persistent focal deficits and poor outcomes.
Conclusions:
- CT scanning is a valuable tool for assessing cerebral involvement in pediatric Haemophilus influenzae meningitis.
- CT findings of ischemic cerebrovascular lesions and infarction are associated with poor neurological outcomes.
- Early CT assessment aids in identifying severe complications and guiding patient management.
Abstract:
In an effort to define the value of computed tomographic (CT) scanning in assessment of cerebral involvement in children with severe Haemophilus influenzae meningitis, we studied 12 children who had focal neurologic deficits on admission or within the early days of illness. The CT scan reliably excluded abscess and cerebritis and suggested ischemic cerebrovascular lesions in 11 of 12 children. Scans performed early in the hospital course generally showed low-density lesions occurring in a vascular distribution without detectable mass effect or enhancement. Later in the clinical course there was consistent enhancement of gray matter or diffuse enhancement in the area of the vascular lesion. The duration of symptoms of meningitis ranged from five to 21 days (mean, 13 days) and appeared to predispose to these vascular lesions. A CT scan consistent with infarction of brain parenchyma occurred predictably in patients with persistent focal neurologic deficits and was correlated with poor outcome.