Posttraumatic meningitis in adolescents and children.
To define the clinical features of posttraumatic meningitis in the pediatric age group, we have reviewed 7 cases presenting to Children's Hospital-San Diego between 1981 and February 1988. Ages ranged from 3 to 16 years with 4 of the 7 patients being adolescents (greater than 13 years of age). These 4 adolescents accounted for 25% of the adolescent bacterial meningitis and all cases of nonmeningococcal meningitis in this age group. Six of 7 patients had positive cerebrospinal fluid (CSF) cultures and positive blood cultures. Organisms were Streptococcus pneumoniae (4), group A streptococcus (1), and Haemophilus influenzae (1). Five of the 7 patients required intensive cardiovascular and respiratory support. Four patients had a good neurologic recovery, 2 patients had neurologic sequelae, and 1 suffered sensorineural hearing loss. These data suggest that direct invasion of the CSF by bacteria may cause sepsis and cardiovascular compromise. Further, in adolescents with nonmeningococcal bacterial meningitis, a history of previous head trauma and CSF leakage should be sought and radiographic evaluation for CSF fistula should be considered.
Wilson
N W
NW
Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla.
Copeland
B
B
Bastian
J F
JF
D000293:Adolescent; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D002648:Child; D006801:Humans; D016920:Meningitis, Bacterial / Q000209:etiology*; D008583:Meningitis, Haemophilus / Q000209:etiology; D008586:Meningitis, Pneumococcal / Q000209:etiology; D009777:Occipital Bone / Q000293:injuries*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000209:etiology*; D013290:Streptococcal Infections / Q000209:etiology; D013297:Streptococcus pyogenes