Diffusion-weighted imaging in acute bacterial meningitis in infancy

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...

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Bibliographic Details
Published in:Neuroradiology 2003-09, Vol.45 (9), p.634-639
Main Authors: JAN, W, ZIMMERMAN, R. A, BILANIUK, L. T, HUNTER, J. V, SIMON, E. M, HASELGROVE, J
Format: Article
Language:English
Subjects:
Bacterial diseases
Bacterial diseases of the nervous system. Bacterial myositis
Biological and medical sciences
Cerebral Infarction - etiology
Cerebral Infarction - pathology
Child, Preschool
Diffusion Magnetic Resonance Imaging
Disease Progression
Empyema - etiology
Empyema - pathology
Fatal Outcome
Female
Frontal Lobe - pathology
Human bacterial diseases
Humans
Infant
Infant, Newborn
Infectious diseases
Male
Medical sciences
Meningitis, Bacterial - complications
Meningitis, Bacterial - pathology
Prognosis
Vasculitis, Central Nervous System - etiology
Vasculitis, Central Nervous System - pathology
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Summary: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.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-003-1035-8