Abstract
Clinical experience suggests that meningoencephalitis in childhood is more common than formerly supposed, and it has been suggested that as the symptoms are often mild and non‐characteristic, at least in children, many cases still remain concealed unless the possibility of mild meningoencephalitis be continously borne in mind.It has also been stressed that even these mild forms of meningo‐encephalitis are often followed by sequels, especially behaviour disorders, but hitherto no investigation, at least not on a large series, has been available to support this belief.With this in mind, all of the cases of meningo‐encephalitis seen at the Pediatric Clinic, University Hospital, Lund, and classed as apparently spontaneous meningo‐encephalitis, meningo‐encephalitis after respiratory tract infections and CNS involvement in association with varicella were selected. These cases were studied in order to form a more detailed opinion of the clinical picture of these meningo‐encephalitides (and as far as varicella is concerned, of the frequency of CNS involvement). The investigation included a review, at which the children were examined neurologically, psychically, psycho‐metrically and regarding their social adjustment. The observations made were compared with a control series.Unlike earlier series on record, the present material included a large percentage of apparently mild cases of meningoencephalitis and, above all, the results were judged in relation to a control series.CNS‐involvement in association with apparently mild infections of the respiratory tract was found to be fairly common, especially in children below 1 year.The clinical picture of spontaneous meningoencephalitis was not found to differ from that of post‐catarrhal meningoencephalitis: these groups did, however, differ with respect to age‐distribution and seasonal occurrence. This suggests the possibility of difference in etiology, i. e. a viral origin for the spontaneous group and a toxic origin for the post‐catarrhal group.The early prognosis was as a rule good.Of the 102 cases, 3 recurred during the time of the investigation. In all 3 the clinical picture was exactly the same as that described for the first attack. This suggests decreased local resistance following the first injury, a decrease that becomes apparent if the brain is exposed to some injurious factor: inflammatory or toxic.Comparison of the patients of the spontaneous and post‐catarrhal groups at the review showed no difference regarding neurologic, psychiatric or psychometric symptoms or social adjustment. These two groups were therefore taken together in the comparison with the controls. This comparison revealed a statistically significant difference between the patients and the controls regarding neurologic and emotional symptoms, mental development and most of the special tests used at the psychometric investigation. A statistical difference was also demonstrated regarding social adjustment. Many of the patients had difficulties at school, despite normal intelligence quotient. These school difficulties were due to a certain extent to emotional disturbances, mostly to special impairments; inability to integrate different perceptions, impaired memory and impaired attention. As the patients and the controls were comparable, with the exception that the patient had had known meningo‐encephalitis, the difference between the observations made at the review must be regarded as sequels after meningoencephalitis.The frequency of brain injury in the patients, as compared with that in the controls, was taken as a measure of the frequency of sequels from meningo‐encephalitides. As judged in this way, the frequency of sequels after these meningo‐encephalitides was about 35 per cent.All of the sequels showed a strong tendency to subside and to become less pronounced with increasing age. Those symptoms that persisted were as a rule mild and meant only a slight handicap for the patient, and only in a few isolated cases were the symptoms so severe as to lead to disability or social maladjustment.The sexes were not found to differ regarding prognosis. Neither did the age at the time of the onset appear to be of prognostic importance. In the event of symptoms of meningitis only, or of meningo‐encephalitides of rapid and mild course, the prognosis appears to be more favourable.CNS involvement was found to be fairly common in varicella (22 per cent). It was observed as a mild clinical form of meningo‐encephalitis or as asymptomatic pleocytosis. At review none of these children showed definite sequels attributable with certainty to the primary disease. In 1 child, however, severe, though transient, behaviour disorders were noted.The cell and protein content of the CSF and the effect of previous puncture were studied on normal children.On the basis of these studies the upper normal limit for the cell count for children above 3 months may be taken as 3 cells/mm3. As to the protein content, Bisgaard 15 may be regarded as the upper normal limit.For children below 3 months the upper limits for both the cell count and the protein content may be somewhat higher.Earlier lumbar puncture has no effect on the protein content, but if the interval between two consecutive punctures is less than 8 days, the cell count may be increased.
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