DOCSLIB.ORG

The Epidemiology, Management, and Outcomes of Bacterial Meningitis In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Epidemiology, Management, and Outcomes of Bacterial Meningitis In The Epidemiology, Management, Lynda Ouchenir, MD, a Christian Renaud, MD, MSc, a Sarah Khan, MD,b Ari Bitnun, MD, MSc, b Andree-Anne Boisvert, MD,c andJane McDonald, Outcomes MD, c Jennifer Bowes, MSc, d Jasonof Brophy, Bacterial MD, MSc, d Michelle Barton, MD, MSc, e f f g g MeningitisJoseph Ting, MBBS, MPH, Ashley Roberts,in MD,Infants MEd, Michael Hawkes, MD, PhD, Joan L. Robinson, MD OBJECTIVES: abstract The pathogens that cause bacterial meningitis in infants andStreptococcus their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in METHODS: early infancy. This was a cohort study of infants <90 days of age with bacterial meningitis at 7 RESULTS: n pediatric tertiary care hospitals across Canada in 2013 and 2014. n There were 113 patients diagnosed with provenEscherichia meningitis coli ( =n 63) or suspected meningitisn ( = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogensE coli were Haemophilus influenzae ( = 37; 33%) and GBS ( = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin ( Listeria and monocytogenes n Enterobacter type B). Six cloacaeof 60 infantsCronobacter presenting sakazakii a diagnosisPseudomonas of meningitis stutzeri from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice ( [ = 3], , , and ). Sequelae were documented in 84 CONCLUSIONS: E coli infants (74%), including 8 deaths (7%). and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram- negative meningitis. WHA T’S KNOWN ON THIS SUBJECT: Before the use of aCentre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; bDepartment of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; cMontreal Children’s intrapartum antibiotics for group B Streptococcus Hospital, McGill University, Montreal, Quebec, Canada; dChildren’s Hospital of Eastern Ontario, University of (GBS), common pathogens in bacterial meningitis Ottawa, Ottawa, Ontario, Canada; eLondon Health Sciences Centre, Western University, London, Ontario, Canada; in the first 90 days of life were GBS and Escherichia fBritish Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and coli. Ampicillin and cefotaxime were effective for gDepartment of Pediatrics, Stollery Children s Hospital, University of Alberta, Edmonton, Alberta, Canada ’ almost all community-acquired cases. Dr Ouchenir collected data from her site, performed the initial data analysis, and wrote the first WHAT THIS StUDY ADDS: GBS and E coli are still the draft of the manuscript; Drs Khan and Boisvert and Ms Bowes collected data from their sites and main pathogens. Three of 60 cases of community- critically reviewed the manuscript; Drs Barton, Ting, and Roberts provided input for the protocol and case report form, collected data from their sites, and critically reviewed the manuscript; acquired late-onset bacterial meningitis were Drs Renaud, Bitnun, McDonald, and Brophy provided input for the protocol and case report form, with Gram-negative pathogens for which a third- supervised data collection from their sites, and critically reviewed the manuscript; Dr Hawkes generation cephalosporin would be suboptimal provided input for the protocol and case report form, performed the data analysis, and critically therapy. reviewed the manuscript; Dr Robinson wrote the first draft of the protocol, designed the case report form, and finalized the manuscript for submission; and all authors approved the final To cite: Ouchenir L, Renaud C, Khan S, et al. The Epide- manuscript as submitted. miology, Management, and Outcomes of Bacterial Men- ingitis in Infants. Pediatrics. 2017;140(1):e20170476 Downloaded from www.aappublications.org/news by guest on September 29, 2021 PEDIATRICS Volume 140, number 1, July 2017:e20170476 ARTICLE ρ There is a paucity of information (including urine) and either sterile rank correlation coefficient ( ). on the characteristics of neonatal CSF pleocytosis or head imaging The Statistical Package for the Haemophilus influenzae × meningitis in the era of infant consistent with bacterial meningitis. Social Sciences version 19 (IBM type B (Hib) CSF pleocytosis was defined as >30 Corporation, Armonk, NY) and Streptococcus 6 × and pneumococcal immunization, 10 /L white blood6 cells (WBCs) and GraphPad Prism version 5 (GraphPad maternal group B (1) <100 10 /L red blood cells Software, La Jolla, CA) were used (GBS) prophylaxis, and emerging1 (RBCs), or (2) WBC:RBC ratio >1:100. for statistical analysis and graphical antimicrobial resistance. The Early-onset was defined as diagnosis display of data, respectively. primary objective of this study was on day 0 to 6, late-onset as day 7 to In analyzing antimicrobial to describe pathogens in bacterial 29, and extremely late-onset as day 2 susceptibility data, it is an accepted meningitis in the first 90 days of E30xclusion to 90. Criteria principle that empirical treatment of life in Canada. Secondary objectives bacterial meningitis should almost were to make inferences about always include an antibiotic to which optimal empirical antimicrobial Exclusion criteria were (1) growth the pathogen is susceptible. agents, outline the typical duration of a common skin contaminant RESULTS of treatment, and describe outcomes. (including coagulase negative The hypothesis was that third- staphylococci) from a single CSF ≤ generation cephalosporins may culture, (2) full recovery despite no longer be optimal for empirical 4 days intravenous antimicrobial There were 424 charts with 1 or therapy of late-onset, community- more target discharge diagnoses, Dagents,ata Collection or (3) fungal isolate. n acquired meningitis. yielding 113 cases of provenn bacterial METHODS meningitis ( = 63) or suspected bacterial meningitis ( = 50) in Data collected via the Research 61 boys and 52 girls (68 term; 45 – Electronic Data Capture included preterm) with a median age of Study results were reported by demographics, microbiologic diagnosis of 19 days (IQR 10 33) using The Strengthening the results (including susceptibilities, (Table 1). Sixty-three patients (56%) Reporting of Observational Studies ≥ CSF sampling results, and head were presented from home, of which in Epidemiology guidelines (https:// ’ / imaging results from symptom 54 (86%) were term infants ( 37 www. equator- network. org/ onset until antibiotic completion), weeks gestation). The other 50 reporting-guidelines/ strobe ). duration of antimicrobial agents patients (44%) presented during Ethics approval was obtained at 7 for meningitis, complications of their birth hospitalization, of pediatric hospitals for a retrospective meningitis (including seizures, which 14 (28%) were term infants chart review of infants born January hydrocephalus, brain abscesses, (Table 2). International1, 2013 through Statistical December Classification 31, suspected ventriculitis, or infarcts), E coli of2014. Diseases Cases and were Related identified Health by the and sequelae at last encounter Pathogens are shown in Table 1 Problems, Tenth Revision, Canada (seizure disorder, hearing or vision with (37/113; 33%) and GBS loss, motor deficits, developmental (35/113; 31%) dominating. Blood Ddelay,ata A ornalysis death). cultures performed in 61 of 63 diagnostic codes for target discharge proven cases were positive for the (SupplementalInclusion Criteria Information). meningitis pathogen in 40 of those cases (66%). Descriptive and comparative statistics were calculated as Forty (80%) of the 50 patients with Infants with onset of bacterial appropriate, expressing continuous suspected meningitis had bacteremia meningitis in the first 90 days of variables by using median and with CSF sampled only post- life were included in this study. interquartile range (IQR) because antibiotics. Nine of the remaining 10 Proven meningitis was defined data were generally not normally patients had sterile CSF pleocytosis as the detection of bacteria from distributed. Comparisons of pre-antibiotics (data missing for 1 – E coli cerebrospinal fluid (CSF) by culture continuous variables were performed patient) with a median CSF leukocyte – U or molecular techniques during life by using nonparametric methods count of 132 (rangen 5 545). or at autopsy. Suspected meningitis (Mann Whitney test). Comparisons was isolated from 7 patients from χ ’ n was defined as the detection of a of proportions2 were performed by blood and urine ( = 2), blood and bacteria recognized to cause central using test or Fisher s exact test, endotracheal secretions ( = 1), ’ n n E nervous system infection from blood as appropriate. Correlations were urine and endotracheal secretions or another normally sterile site quantified by using Spearman s ( = 1), and urine alone ( = 3). Downloaded from www.aappublications.org/news by guest on September 29, 2021 2 OUCHENIR et al TABLE 1 Characteristics of 113 Neonates With Proven or Suspected Bacterial
Load more

Recommended publications
  • Cerebrospinal Fluid in Critical Illness
    Cerebrospinal Fluid in Critical Illness B. VENKATESH, P. SCOTT, M. ZIEGENFUSS Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, QUEENSLAND ABSTRACT Objective: To detail the physiology, pathophysiology and recent advances in diagnostic analysis of cerebrospinal fluid (CSF) in critical illness, and briefly review the pharmacokinetics and pharmaco- dynamics of drugs in the CSF when administered by the intravenous and intrathecal route. Data Sources: A review of articles published in peer reviewed journals from 1966 to 1999 and identified through a MEDLINE search on the cerebrospinal fluid. Summary of review: The examination of the CSF has become an integral part of the assessment of the critically ill neurological or neurosurgical patient. Its greatest value lies in the evaluation of meningitis. Recent publications describe the availability of new laboratory tests on the CSF in addition to the conventional cell count, protein sugar and microbiology studies. Whilst these additional tests have improved our understanding of the pathophysiology of the critically ill neurological/neurosurgical patient, they have a limited role in providing diagnostic or prognostic information. The literature pertaining to the use of these tests is reviewed together with a description of the alterations in CSF in critical illness. The pharmacokinetics and pharmacodynamics of drugs in the CSF, when administered by the intravenous and the intrathecal route, are also reviewed. Conclusions: The diagnostic utility of CSF investigation in critical illness is currently limited to the diagnosis of an infectious process. Studies that have demonstrated some usefulness of CSF analysis in predicting outcome in critical illness have not been able to show their superiority to conventional clinical examination.
    [Show full text]
  • Introduction Neuroimaging of the Brain
    Introduction Neuroimaging of the Brain John J. McCormick MD Normal appearance depends on age Trauma • One million ER visits/yr • 80,000/yr develop long term disability • 50,000/yr die • 46% from transportation; 26% falls; 17% assaults. Other causes, such as sports injuries, account for rest. • 2/3 < 30yrs old • Men 2X as likely to be injured • Cost of TBI is $48.3 billion annually • A patient in mid-twenties with severe head injury is estimated to have a lifetime cost of 4 million dollars including lost work hours, medical and daily care Skull Fracture • Linear or depressed • Skull base, middle meningeal artery • Differentiate from suture and venous channels Sutures Traumatic Subarachnoid Hemorrhage Acute Subdural Hemorrhage Subacute Subdural Hematoma Chronic Subdural Hemorrhage Epidural Hematoma Diffuse Axonal Injury Coup-Contracoup Intraventricular Hemorrhage Stroke National Stroke Ass’n Stats • Third leading cause of death in US • Someone suffers stroke every 53 seconds and every 3.3 minutes someone dies of a stroke • 28% of those who suffer from stroke are under 65 • 15-30% are permanently disabled and require institutional care • Estimated direct and indirect annual cost of stroke un US is 43.4 billion dollars Stroke Subtypes • Two major types: hemorrhagic and ischemic • Hemmorrhagic strokes caused by blood vessel rupture and account for 16% of strokes • Ischemic strokes include thrombotic, embolic, lacunar and hypoperfusion infarctions Intracebral Hemorrhage • Most common cause: hypertensive hemorrhage • Other causes: AVM, coagulopathy,
    [Show full text]
  • Successful Management of Nosocomial Ventriculitis and Meningitis Caused by Extensively Drug-Resistant Acinetobacter Baumannii in Austria
    CASE REPORT Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumannii in Austria M Hoenigl MD1,2*, M Drescher1*, G Feierl MD3, T Valentin MD1, G Zarfel PhD3, K Seeber MSc1, R Krause MD1, AJ Grisold MD3 M Hoenigl, M Drescher, G Feierl, et al. Successful management La prise en charge réussie d’une ventriculite et of nosocomial ventriculitis and meningitis caused by extensively d’une méningite d’origine nosocomiale causées par drug-resistant Acinetobacter baumannii in Austria. Can J Infect un Acinetobacter baumannii d’une extrême Dis Med Microbiol 2013;24(3):e88-e90. résistance aux médicaments en Autriche Nosocomial infections caused by the Gram-negative coccobacillus Les infections d’origine nosocomiale causées par le coccobacille Acinetobacter baumannii have substantially increased over recent years. Acinetobacter baumannii Gram négatif ont considérablement augmenté Because Acinetobacter is a genus with a tendency to quickly develop ces dernières années. Puisque l’Acinetobacter est un genre qui a ten- resistance to multiple antimicrobial agents, therapy is often compli- dance à devenir rapidement résistant à de multiples agents antimicro- cated, requiring the return to previously used drugs. The authors report biens, le traitement est souvent compliqué et exige de revenir à des a case of meningitis due to extensively drug-resistant A baumannii in an médicaments déjà utilisés. Les auteurs signalent un cas de méningite Austrian patient who had undergone neurosurgery in northern Italy. attribuable à un A baumannii d’une extrême résistance aux médica- The case illustrates the limits of therapeutic options in central nervous ments chez un patient autrichien qui a subi une neurochirurgie dans le system infections caused by extensively drug-resistant pathogens.
    [Show full text]
  • A Review of Clinically Suspected Sepsis and Meningitis in Infants Under 90 Days Old in a Tertiary Care Center in Saudi Arabia
    Journal of Microbiology and InfectiousBukhari Diseases EE, et / al. Sepsis and meningitis in infants 2011; 1 (2): 47-5247 JMID doi: 10.5799/ahinjs.02.2011.02.0012 ORIGINAL ARTICLE A review of clinically suspected sepsis and meningitis in infants under 90 days old in a tertiary care center in Saudi Arabia Elham Essa Bukhari, Abdulkarim Abdullah Alrabiaah Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia ABSTRACT Objectives: Infections in infants<90 days old are the leading cause of morbidity and hospitalization in neonatal prac- tice. The etiological agents of sepsis (with or without meningitis) in Saudi neonates <90 days old are vastly under- characterized. The aim of this study was to determine the bacterial etiology of neonatal sepsis and meningitis in these infants. Materials and methods: This retrospective study was conducted in King Khalid University Hospital, Riyadh, in the pe- riod from January 2007 to January 2011. All infants<90 days old with suspected sepsis during this period were examined for evidence of infection. Cultures, including blood and Cerebrospinal fluid (CSF) were performed for all neonates. Results: A total of 304 cases of sepsis in infants <90 days were investigated. Community-acquired neonatal sepsis com- posed 284 of the studied cases present after the age of one month, while 20 infants were identified as having neonatal sepsis in the first month of life. Only 12 blood cultures were positive (four isolates of Staphylococcus epidermidis, two Staphylococcus aureus, two Staphylococcus hominis, one Enterobacter cloacae, one group B streptococcus, one diphthe- roids and one with Bacillus species).
    [Show full text]
  • Of CMV Ventriculitis CMV Ventriculoencephalitis Is Characterized by Sub- Acute Delirium, Cranial Neuropathies, and Nystagmus
    Alzhemier’s disease in women: randomized, double-blind, 23. Crystal H, Dickson D, Fuld P, et al. Clinico-pathologic studies placebo-controlled trial. Neurology 2000;54:295–301. in dementia-nondemented subjects with pathologically con- 22. Mulnard RA, Cotman CW, Kawas C, et al. Estrogen replace- firmed Alzheimer’s disease. Neurology 1988;38:1682–1687. ment therapy for treatment of mild to moderate Alzheimer’s 24. Price JL, Morris JC. Tangles and plaques in nondemented disease: a randomized control trial. Alzheimer’s Disease aging and “preclinical” Alzheimer’s disease. Ann Neurol 1999; Coopertive Study. JAMA 2000;283:1007–1015. 45:358–368. NeuroImages Figure. (A) Fluid-attenuated inversion recovery MRI sequence demonstrates prominent abnormal signal outlining the ventricles. (B) Cytomegalovirus (CMV)-infected macrophages in a patient with CMV ventriculoencephalitis. “Owl’s eyes” of CMV ventriculitis CMV ventriculoencephalitis is characterized by sub- acute delirium, cranial neuropathies, and nystagmus. The Devon I. Rubin, MD, Rochester, MN pathologic hallmark is the cytomegalic cell, a macrophage A 35-year-old HIV-positive man with a history of cyto- containing intranuclear and intracytoplasmic inclusions of megalovirus (CMV) retinitis presented with fever, diplopia, cytomegalic virus particles, resembling and referred to as and progressive obtundation over 1 week. Neurologic ex- “owl’s eyes” (figure, B). MRI findings in CMV ventriculoen- amination revealed a fluctuating level of alertness, bilat- cephalitis include diffuse cerebral atrophy, progressive eral gaze-evoked horizontal nystagmus, a left facial palsy, ventriculomegaly, and a variable degree of periventricular and diffuse areflexia. MRI demonstrated generalized atro- or subependymal contrast enhancement.1 Newer imaging phy and ventriculomegaly with increased signal in the left sequences, such as FLAIR, may be more sensitive in de- caudate head on T1-weighted, gadolinium-enhanced im- tecting ventricular abnormalities.
    [Show full text]
  • The Epidemiology of Meningitis in Infants Under 90 Days of Age in a Large Pediatric Hospital
    microorganisms Article The Epidemiology of Meningitis in Infants under 90 Days of Age in a Large Pediatric Hospital Timothy A. Erickson 1,2, Flor M. Munoz 3, Catherine L. Troisi 2 , Melissa S. Nolan 4 , Rodrigo Hasbun 5, Eric L. Brown 2 and Kristy O. Murray 1,* 1 Department of Pediatrics, Section of Pediatric Tropical Medicine, William T. Shearer Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; [email protected] 2 School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA; [email protected] (C.L.T.); [email protected] (E.L.B.) 3 Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA; fl[email protected] 4 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; [email protected] 5 McGovern Medical School, University of Texas, Houston, TX 77030, USA; [email protected] * Correspondence: [email protected] Abstract: Background: Meningitis is associated with substantial morbidity and mortality, particularly in the first three months of life. Methods: We conducted a retrospective review of patients <90 days of age with meningitis at Texas Children’s Hospital from 2010–2017. Cases were confirmed using the National Healthcare Safety Network (NHSN) definition of meningitis. Results: Among 694 infants with meningitis, the most common etiology was viral (n = 351; 51%), primarily caused by Citation: Erickson, T.A.; Munoz, enterovirus (n = 332; 95%).
    [Show full text]
  • Sharifah Al Muthen Salma Albahrani* Hanan Baradwan Dr. Amal Shilash ABSTRACT KEYWORDS INTERNATIONAL JOURNAL of SCIENTIFIC RESEAR
    ORIGINAL RESEARCH PAPER Volume-8 | Issue-7 | July - 2019 | PRINT ISSN No. 2277 - 8179 INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH PNEUMOCOCCAL MENINGITIS ASSOCIATED PYOGENIC VENTRICULITIS: A CASE REPORT. Medicine Sharifah Al MBBs, Department Of Internal Medicine- Infectious Disease Section Muthen MBBs, SB-Med, ArBIM, SF-ID, Department of Internal Medicine-Infectious Disease Salma AlBahrani* Section *Corresponding Author MBBS, Department of Neurology, King Fahd Military Medical Complex-Dhahran- Hanan Baradwan Eastern Province-Kingdom of Saudi Arabia. MBBS, MSc, Infection Control Department, King Fahd Military Medical Complex- Dr. Amal Shilash Dhahran-Eastern Province-Kingdom Of Saudi Arabia. ABSTRACT Background: Pyogenic ventriculitis is uncommon yet fatal complication of the inflammation of the ventricular ependymal lining associated with a purulent ventricular system. The commonest organism can be gram negative organism especially if happened after neurological procedure . Case report: 63 years old male known case of Diabetes mellitus ( DM), hypertension (HTN), Parkinson diseases (PD), treated lymphoma on chemotherapy four years ago. Presented with high grade fever, delirium and seizure. Admitted to the Intensive Care Unit (ICU) as a case of septic shock. Patient intubated and started on norepinephrine, intravenous fluids, anti-epileptic ( levetiracetam ) as well as anti-meningitis antibiotic (ceftriaxone , vancomycin , ampicillin and acyclovir) plus dexamethasone. His Cerebral Spinal Fluid (CSF) analysis showed: glucose 4.6 (high). CSF protein 3.3 (high), CSF WBC 4000. Blood culture showed streptococcus pneumoniae. Brain MRI was done and showed evidence of ventriculitis in form of fluid level at occipital horn of lateral ventricles, no edema no mass effect no hydrocephalus, left hypocampus hyperintensity. Diagnosis of pyogenic ventriculitis was made.
    [Show full text]
  • Intracranial Mass Lesions and Elevated Intracranial Pressure
    Intracranial Mass Lesions and Elevated Intracranial Pressure Lissa C. Baird, MD Assistant Professor Directory, Pediatric Surgical Neuro-Oncology Department of Neurological Surgery Oregon Health & Science University Conflict of Interest Disclosure Disclosure I do not have any financial relationships to disclose. Intracranial Mass Lesions Overview • I. General Principles of Intracranial Mass Lesions • II. Differential Diagnosis • III. Signs and Symptoms • IV. Clinical Management of Mass Lesions and Elevated Intracranial Pressure I. General Principles of Intracranial Mass Lesions 1 What is an Intracranial Mass Lesion? • Space-occupying lesion • Recognizable volume • Abnormal • May cause mass effect Mass Effect = compression of surrounding structures causes shift (displacement) • May cause elevation of intracranial pressure Description of Intracranial Mass Lesions • Intra-axial • Extra-axial • +/- mass effect • Discrete Lesion • Expansion of Intrinsic anatomy Intra-axial vs Extra-axial • Intrinsic to the brain • Extrinsic to the brain Metastatic tumor meningioma 2 Is there Mass Effect on surrounding brain structures? Pineal cyst Epidural hematoma Expansion of Discrete Lesion or Intrinsic Anatomy? Intraparenchymal Trapped hemorrhage Temporal horn Diffuse intrinsic tumor pontine glioma II. Differential Diagnosis • Neoplasm • Trauma • Infection • Stroke • Cyst • Vascular • Hydrocephalus • Congenital Anomaly 3 Neoplastic Mass Lesions • Intra-axial – Benign • Slow rate of growth • Unlikely to metastasize • Less surrounding edema – Can still cause significant symptoms depending on location Neoplastic Mass Lesions • Intra-axial – Malignant – Metastatic – May be multifocal – Spread within central nervous system – Infiltrate normal brain – Severe Edema Neoplastic Mass Lesions • Extra-axial – Most are benign – Symptoms focally rel at 4 Traumatic Mass Lesions • Hematoma • Depressed Skull Fractures • Foreign Body – Penetrating injuries Layers of the Cranial Vault Subgaleal hematoma • Between galea aponeurotica and periosteum.
    [Show full text]
  • Icp, Intracranial Hypertension S50 (1)
    ICP, INTRACRANIAL HYPERTENSION S50 (1) ICP, Intracranial Hypertension Last updated: December 19, 2020 INTRACRANIAL PRESSURE (ICP) ............................................................................................................ 1 Normal ICP ............................................................................................................................ 2 ICP↑ ......................................................................................................................................................... 2 ETIOLOGY .............................................................................................................................................. 2 PATHOPHYSIOLOGY ............................................................................................................................... 2 Compliance ............................................................................................................................ 2 Cerebral Blood Flow Impairment .......................................................................................... 3 Compartmentalization (ICP gradients) .................................................................................. 4 CLINICAL FEATURES .............................................................................................................................. 4 Mass in posterior fossa .......................................................................................................... 5 MONITORING ........................................................................................................................................
    [Show full text]
  • Septic Venous Thrombosis As an Unexpected Complication of Acute Suppurative Otitis Media
    MOJ Clinical & Medical Case Reports Case Report Open Access Septic venous thrombosis as an unexpected complication of acute suppurative otitis media. case report Abstract Volume 10 Issue 1 - 2020 Cerebral venous thrombosis is a rare condition that primarily affects women. It has been described in association with local factors (meningitis, sinusitis, cellulite and tumors) Ivan Cadena Vélez, Manuela Grego, Luis Siopa and systemic factors such as thrombophilia and other blood disorders. The most common Internal Medicine Department, Hospital Distrital de Santarém, site is the lateral sinus, followed by the sagittal sinus. In 30-40% of cases it affects more Portugal than a venous sinus. The most common clinical manifestation is headache. We present the Ivan Cadena Vélez, Internal Medicine case of a 65-year-old male patient with a history of ethanolism and smoking, admitted Correspondence: Department, Hospital Distrital de Santarém, Portugal, Tel to the Emergency Department for a four-day follow-up, fever, dyspnea and temporary +57914040788, Email disorientation that worsened in the last 24 hours with an altered state of consciousness. Evidenced by diagnostic computed tomography (CT) a ventriculitis and a defect in the Received: January 18, 2020 | Published: January 29, 2020 filling of the transverse sinus and left sigmoid in apparent relationship with thrombosis; and opacification of the middle ear by inflammatory process / otitis media. Thrombosis of cerebral venous sines (CVT) is considered difficult to diagnose due to the wide variety of signs and symptoms that can simulate a large number of other entities, it is important to have this diagnosis always present, and it is essential that after the diagnostic suspicion we can carry out a timely study through non-invasive imaging studies, in order to initiate medical and surgical treatment according to the case and to identify, avoid or minimize the secondary complications or morbidity that it generates.
    [Show full text]
  • HYDROCEPHALUS and SHUNTS: WHAT the NEUROLOGIST SHOULD KNOW *I17 Ian K Pople
    HYDROCEPHALUS AND SHUNTS: WHAT THE NEUROLOGIST SHOULD KNOW *i17 Ian K Pople J Neurol Neurosurg Psychiatry 2002;73(Suppl I):i17–i22 he second most common reason for being sued for negligence in neurosurgery is a problem related to hydrocephalus management (the first being spinal surgery!). However, the good Tnews is that the overall standard of care for patients with hydrocephalus appears to have greatly improved over the last 10 years with the advent of better facilities for investigation, new approaches to treatment, and a greater awareness of the need for adequate follow up. In the possi- ble absence of a local neurosurgeon with an interest in hydrocephalus, a neurologist who is faced with the ongoing care of a patient with hydrocephalus should ideally have a clear idea of what exactly constitutes appropriate follow up and which clinical and radiological warning signals of shunt problems to look out for. c DEFINITIONS Hydrocephalus is an excessive accumulation of cerebrospinal fluid (CSF) within the head caused by a disturbance of formation, flow or absorption. “Hydrocephalus ex vaccuo” is a misnomer. It refers to asymptomatic ventricular enlargement caused by generalised loss of cerebral tissue, from severe head injury, infarction or cerebral hypoxia. “Normal pressure hydrocephalus” is also a misnomer. It describes a condition in older adults of low grade hydrocephalus with intermittently raised intracranial pressure (ICP) (usually at night) causing the classic Adam’s triad of symptoms—gait apraxia, incontinence, dementia. BASIC HYDROCEPHALUS PATHOPHYSIOLOGY IN ADULTS The normal CSF production rate in an adult is 0.35 ml/min (20 ml/hour or 500 ml/24 hours).
    [Show full text]
  • I.6 AB Neonatal Meningitis Copy 2
    2021 WHO Expert Committee on Selection and Use of Essential Medicines Proposal to extend the indications for gentamicin on the EMLc to include acute bacterial meningitis in neonates Submitted by: Dr Veronica Zanichelli, WHO Consultant Dr Mark Loeb and Dr Dominik Mertz, McMaster University 1. Summary statement of the proposal for inclusion, change or deletion. This application concerns the updating of the forthcoming WHO Model List of Essential Medicines for Children (EMLc) to add the new indication of acute bacterial meningitis in neonates to the existing listing for gentamicin. The treatment options for neonatal meningitis of ampicillin in combination with gentamicin, and the use of ceftriaxone or cefotaxime as alternatives to ampicillin are recommended by several WHO guidelines. Ampicillin, ceftriaxone and cefotaxime are currently included on the EMLc for the treatment of acute bacterial meningitis related to their good CSF penetration, safety profile and coverage of the most common pathogens. In neonates, the clinical presentation of meningitis is, however, less typical than in adults or in older children and symptoms are usually non-specific. Neonates with meningitis often present with a combination of fever, poor feeding, lethargy and/or reduced interaction with caregivers, vomiting, irritability, seizures and rash. Neck stiffness is uncommon. These non-specific symptoms overlap with those of “neonatal sepsis” for which there is no universally accepted definition even though the term is most commonly used to describe a serious systemic condition of infectious origin (usually bacterial) that occurs in the first month of life, associated with a combination of clinical and laboratory signs. Therefore, empiric treatment of neonatal meningitis and sepsis overlap, and meningitis should always be suspected in case of signs of serious bacterial infection.
    [Show full text]