Abstract
Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2–5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas.
Similar content being viewed by others
References
Friede RL (1973) Cerebral infarcts complicating neonatal leptomeningitis. Acta Neuropathol 23: 245–253
Heyderman RS, Robb SA, Kendall BE, Levin M (1992) Does computed tomography have a role in the evaluation of complicated acute bacterial meningitis in childhood? Dev Med Child Neurol 34: 870–875
Pfister HW, Feiden W, Einhaupl KM (1993) Spectrum of clinical complications during acute bacterial meningitis in adults: results of a prospective clinical study. Arch Neurol 50: 575–581
Grimwood K (2001) Legacy of bacterial meningitis in infancy: many children continue to suffer functionally important deficits. Br Med J 323: 523–524
Bedford H, Louvois JD, Halket S, Peckham C, Hurley R, Harvey D (2001) Meningitis in infancy in England and Wales: follow up at age 5 years. Br Med J 323: 533–536
Syrjanen J (1993) Infection as a risk factor for cerebral infarction. Eur Heart J 14 [Suppl]: 17–19
Perry JR, Bilbao JM, Gray T (1992) Fatal basilar vasculopathy complicating bacterial meningitis. Stroke 23: 1175–1178
Garg BP, DeMyer WE (1995) Ischemic thalamic infarction in children: clinical presentation, etiology, and outcome. Pediatr Neurol 13: 46–49
Ropper AH, Kanis KB (2000) Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis. J Clin Neurosci 7: 339–341
Norman MG (1982) Respiratory arrest and cervical spinal cord infarction following lumbar puncture in meningitis. Can J Neurol Sci 9: 443–447
Rorke LB (1989) Pathology of cerebral vascular disease in children and adolescents. In: Edwards MSB, Hoffman HJ (eds) Cerebral vascular disease in children and adolescents. Williams and Wilkins, Baltimore, pp 95–138
Huang LT (1996) Salmonella meningitis complicated by brain infarctions. Clin Infect Dis 22: 194–195
Snyder RD, Stovering J, Cushing AH, Davis LE, Hardy TL (1981) Cerebral infarction in childhood bacterial meningitis. J Neurol, Neurosurg Psychiatry 44: 581–585
Foreman SD, Smith EE, Ryan NJ, Hogan GR (1984) Neonatal citrobacter meningitis: pathogenesis of cerebral abscess formation. Ann Neurol 16: 655–659
Ressler JA, Nelson M (2000) Central nervous system infections in the pediatric population. Neuroimaging Clin North Am 10: 427–443
Habre W, Caflisch M, Chaves-Vischer V, delavelle J, Haenggeli CA (1996) Locked-in syndrome in an adolescent patient with pneumococcal meningitis. Neuropediatrics 27: 323–325
Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MRI of the brain in patients with meningitis: comparison with CT. AJNR 11: 69–76
Albers GW (1998) Diffusion-weighted MRI for evaluation of acute stroke. Neurology 51: S47–S49
Zimmerman RA (2000). Pediatric cerebrovascular disease. JBR-BTR 83: 245–252
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jan, W., Zimmerman, R.A., Bilaniuk, L.T. et al. Diffusion-weighted imaging in acute bacterial meningitis in infancy. Neuroradiology 45, 634–639 (2003). https://doi.org/10.1007/s00234-003-1035-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-003-1035-8