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Indications and benefits of computed tomography in childhood bacterial meningitis
A S Daoud1, H Omari, M al-Sheyyab
1Department of Pediatrics, Jordan University of Science & Technology, Irbid, Jordan.
Insights
Head CT scans accurately diagnose bacterial meningitis complications in children. However, their therapeutic value is limited, mainly aiding complex seizure disorders, not prolonged fever.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Infectious Diseases
Background:
- Bacterial meningitis can lead to serious intracranial complications in children.
- Computed tomography (CT) of the head is a key diagnostic tool.
Purpose of the Study:
- To evaluate the diagnostic yield and therapeutic relevance of head CT scans in children with acute bacterial meningitis.
Main Methods:
- Retrospective review of 58 children with acute bacterial meningitis who underwent head CT over 5 years.
- Analysis of CT findings in relation to clinical presentation and indications for scanning.
Main Results:
- Abnormal CT findings were present in 47% of patients.
- Common abnormalities included subdural collections (33%) and hydrocephalus (7%).
- Therapeutically relevant findings were noted in only 10% of cases.
Conclusions:
- Head CT is accurate for diagnosing intracranial complications of bacterial meningitis.
- CT is most indicated for persistent neurologic dysfunction, such as complex seizures.
- CT has limited value for prolonged fever alone in this context.
Abstract:
Over a 5 year period, 58 children with acute bacterial meningitis underwent computed tomography (CT) of the head. The major stated indications were partial, complex, or prolonged seizures in children younger than 5 years (60 per cent) and prolonged fever in the case of those older than 5 years (60 per cent). Abnormal findings on CT scan were seen in 27 (47 per cent); the remaining 31 (53 per cent) patients had normal or only non-specific dilatation of spaces containing cerebrospinal fluid (CSF) or basilar enhancement. The commonest CT abnormalities were seen in those patients who presented with complex seizure disorders. The commonest abnormal findings were subdural collection (33 per cent) followed by hydrocephalus (7 per cent). Subdural collection was seen mainly in patients with Haemophilus influenzae bacterial meningitis (90 per cent) while hydrocephalus was mainly seen in tuberculous meningitis. Positive findings of obvious therapeutic clinical relevance were present in only six cases (10 per cent). From the study we concluded that head CT provides an accurate means of diagnosing intracranial complications of bacterial meningitis, but it must be used conservatively as it has limited therapeutic applications in children with complicated bacterial meningitis. Computed tomography is indicated mainly in children with persistent neurologic dysfunction like complex seizure disorder, and is of little value in children with prolonged fever alone.