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Cerebral herniation during bacterial meningitis in children
G Rennick1, F Shann, J de Campo
1Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
BMJ (Clinical Research Ed.)
|April 10, 1993
Summary
Lumbar puncture may trigger cerebral herniation in children with bacterial meningitis, especially within 12 hours. Normal CT scans do not rule out this risk, highlighting the need for caution.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Radiology
Background:
- Bacterial meningitis is a serious infection in children.
- Cerebral herniation is a life-threatening complication.
- Lumbar puncture is a diagnostic tool but carries potential risks.
Purpose of the Study:
- To investigate the incidence of cerebral herniation following lumbar puncture in children with bacterial meningitis.
- To determine if normal cranial computed tomography (CT) findings exclude herniation risk after lumbar puncture.
Main Methods:
- Retrospective review of medical records from a pediatric teaching hospital.
- Analysis of 445 children diagnosed with bacterial meningitis.
- Re-evaluation of cranial CT scans and timing of herniation events in relation to lumbar puncture.
Main Results:
- Cerebral herniation occurred in 4.3% of children (19/445).
- In children who underwent lumbar puncture, 19 herniation episodes occurred, with 12 happening within 12 hours (OR 32.6).
- Cranial CT scans were normal in 36% (5/14) of herniation episodes.
Conclusions:
- A strong temporal association suggests lumbar puncture can precipitate herniation in some pediatric meningitis cases.
- Normal cranial CT results do not guarantee safety when performing lumbar puncture in children with bacterial meningitis.