Clinical characteristics of purulent meningitis complicated with subdural effusion

Abstract

Objective To summarize clinical characteristics of children with purulent meningitis complicated with subdural effusion. Methods We reviewed a total of 291 children with purulent meningitis hospitalized between January 1992 and December 1999, 188 were boys and 103 were girls, the age of the patients ranged from 10 days to 13 years. Results Of the 291 cases, 80 were complicated with subdural effusion, the morbidity was 27.5%, the anterior fontanels of all these children were unclosed and in 82.5% of them there was bilateral subdural effusion. Of the 80 cases complicated with subdural effusion, 37 children (46.3%) had pneumococcal meningitis, and 21 cases (26.3%) had Hemophilus influenzae meningitis. The morbidity of subdural effusion varried in patients with different bacterial meningitis. Subdural effusion developed in 78.8% of the 80 cases between days 4 and 10 after the onset of the meningitis. In the 80 cases with subdural meningitis, 7 had simple subdural effusion; 45 had subdural infection ; 28 had subdural empyema and two of them died. Of the 291 cases, B-type ultrasound and CT examinations revealed evidences of small amount subdural effusion in 77 cases, but the symptoms and signs of intracranial hypertension were not demonstrated clinically. Conclusion Subdural effusion occurred quite often among children with pneumococcal and Hemophilus influenzae meningitis, and many of the cases had no apparent clinical manifestations. Therefore, further imaging examinations are needed to find out subdural effusions. Once the diagnosis of the subdural effusion, infection or subdural empyema is established, proper treatment should be started. Even if there are no symptoms and signs of intracranial hypertension, subdural puncture is necessary; local antibiotics may be applied via the subdural puncture. The subdural effusion could be absorbed in 6 months with active and proper treatment. For the small amount of the subdural effusion or for the patients without intracranial hypertension, the subdural effusion should not be applied because such effusions could be absorbed within 3 months. Key words: Meningitis pneumococcal; Meningitis, haemophilus; Empyema, subdural