Prospective neurosonographic study in infantile purulent meningitis

Fourteen infants or neonates with purulent meningitis underwent prospective brain sonography follow-up for early detection of intracranial complications. Most patients had 12 scans during a 6 month period. The children's ages ranged from 5 days to 11 months. Early surgical intervention is suggested in progressive ventricular dilatation or severe subdural fluid collection. One patient with hydrocephalus had ventriculoperitoneal shunting. Three patients developed subdural empyema. One had subdural external drainage; and repeat subdural tappings were done in the other two. All these patients recovered without obvious neurologic sequelae. Two other patients developed ventricular dilatation one month after the onset of meningitis. Hydrocephalus ex vacuo was suspected and there were no indications for shunt surgery. These latter two cases had developed mild psychomotor retardation on their last follow-up. This primitive observation suggests that early detection with prospective, sequential sonography follow-up and appropriate surgical intervention for hydrocephalus or subdural fluid collection may lessen the neurologic sequelae in infantile and neonatal purulent meningitis.