title: Brain magnetic resonance imaging of infants with bacterial meningitis.
abstract: OBJECTIVE
  To describe the results of brain magnetic resonance imaging (MRI) of infants with bacterial meningitis and how the findings affected clinical management.
  
  
  METHODS
  This retrospective study included all infants <12 months of age who were hospitalized at Children's Medical Center, Dallas and had culture-confirmed bacterial meningitis and a brain MRI from January 1, 2001 to December 1, 2011. Infants were identified by review of all positive bacterial cultures of cerebrospinal fluid (CSF) from the Children's Medical Center Microbiology Laboratory. Demographic, clinical, laboratory, and neuroimaging data were reviewed. Infants with ventriculoperitoneal shunt or whose CSF culture yielded skin commensals were excluded. A neuroradiologist blinded to clinical information reviewed all MRI studies.
  
  
  RESULTS
  Of the 440 infants who had a positive CSF culture result, 111 (25%) had a pathogen isolated from CSF and were enrolled in the study. Of these, 68% (75/111) had a brain MRI performed during the hospitalization; abnormalities included leptomeningeal enhancement (57%), cerebral infarct (43%), subdural empyema (52%), cerebritis (26%), hydrocephalus (20%), and abscess (11%). By multiple logistic regression analysis, infants with late seizures and an abnormal neurologic examination were more likely to have an abnormal MRI (P < .05). MRI results led to neurosurgical intervention in 23% of infants; a positive bacterial culture of CSF obtained >48 hours after initiation of antibiotic therapy was associated with neurosurgical intervention (P = .01). Fourteen (19%) infants with bacterial meningitis had a normal brain MRI.
  
  
  CONCLUSIONS
  Brain MRIs were performed frequently and often were abnormal in infants with bacterial meningitis, leading to changes in clinical management.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Oliveira
authors.affiliation: Children's Medical Center, Dallas, TX; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Morriss
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
authors.forename: John G
authors.initials: JG
authors.lastname: Mistrot
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Cantey
authors.affiliation: Children's Medical Center, Dallas, TX; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Doern
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Children's Medical Center, Dallas, TX. Electronic address: pablo.sanchez@nationwidechildrens.org.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
mesh_terms: D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies; D013781:Texas
references.citation: Infect Dis Clin North Am. 1999 Sep;13(3):711-33, viii
references.pmid: 10470563
references.citation: Lancet Infect Dis. 2010 Jan;10(1):32-42
references.pmid: 20129147
references.citation: Pediatr Infect Dis J. 1988 Mar;7(3):196-9
references.pmid: 3282215
references.citation: Eur J Radiol. 2011 Dec;80(3):821-7
references.pmid: 21067879
references.citation: Arch Dis Child. 1991 May;66(5):603-7
references.pmid: 2039250
references.citation: Arch Dis Child Fetal Neonatal Ed. 2001 Mar;84(2):F85-9
references.pmid: 11207221
references.citation: Childs Nerv Syst. 1985;1(4):211-4
references.pmid: 2866033
references.citation: JAMA. 1981 May 15;245(19):1923-5
references.pmid: 7230384
references.citation: J Trop Pediatr. 1995 Apr;41(2):81-5
references.pmid: 7776402
references.citation: N Engl J Med. 2002 Jun 6;346(23):1792-8
references.pmid: 12050339
references.citation: Indian J Pediatr. 2007 Feb;74(2):173-84
references.pmid: 17337831
references.citation: Laryngoscope. 1978 May;88(5):739-55
references.pmid: 642669
references.citation: Arch Dis Child Fetal Neonatal Ed. 2003 May;88(3):F173-8
references.pmid: 12719388
references.citation: Pediatrics. 1984 May;73(5):579-86
references.pmid: 6718112
references.citation: BMJ. 2001 Sep 8;323(7312):523-4
references.pmid: 11546680
references.citation: Southeast Asian J Trop Med Public Health. 1994 Mar;25(1):107-15
references.pmid: 7824999