Related Experiment Videos
Cerebral herniation during bacterial meningitis in children
G Rennick1, F Shann, J de Campo
1Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
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.
Objective:
To see whether the incidence of cerebral herniation is increased immediately after lumbar puncture in children with bacterial meningitis and whether any children with herniation have normal results on cranial computed tomography.
Design:
Retrospective review of case notes; computed tomograms were read again.
Setting:
Large paediatric teaching hospital.
Subjects:
445 children over 30 days old admitted to hospital with bacterial meningitis.
Main Outcome Measures:
Timing of herniation in relation to lumbar puncture; findings on computed tomography in children with herniation.
Results:
Cerebral herniation was detected in 19 (4.3%) of the 445 children (21 episodes; herniation occurred twice in two children). Herniation occurred in 14 (45%) of the 31 children who died. Nineteen episodes of herniation occurred in the 17 children who had a lumbar puncture; 12 of the episodes occurred in the first 12 hours after the lumbar puncture and seven over six other 12 hour periods (odds ratio 32.6 (95% confidence interval 8.5 to 117.3); p < 0.001). The results of cranial computed tomography were normal in five (36%) of the 14 episodes of herniation in which scanning was performed at about the time of herniation.
Conclusions:
The temporal relation between lumbar puncture and herniation strongly suggests that a lumbar puncture may cause herniation in some patients, and normal results on computed tomography do not mean that it is safe to do a lumbar puncture in a child with bacterial meningitis.