Cerebral herniation during bacterial meningitis in children.

Rennick, Gordon J; Shann, F; Campo, John de

doi:10.1136/bmj.306.6883.953

Cited by 172 publications

(112 citation statements)

References 7 publications

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“…27,28 There were some case series that reported outcomes after brain herniation (Table 3). [29][30][31][32][33][34][35] Unfortunately, none of these specifically commented on whether the outcomes in survivors were due to spinal cord injury. These series show that there is a high mortality after brain herniation, and that 25-50% of survivors are left with severe sequelae, including 'spastic limbs.'…”

Section: Resultsmentioning

confidence: 99%

“…These series show that there is a high mortality after brain herniation, and that 25-50% of survivors are left with severe sequelae, including 'spastic limbs.' [29][30][31][32][33][34][35] In one series of traumatic transtentorial herniation, cardiac arrest, flaccidity or bilateral fixed pupils after the herniation predicted worse neurological outcome. 33 We found only two case series of BD that specifically commented on the pathological findings in the spinal cord (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…19,28 Third, severe sequelae in survivors of herniation are common, and likely attributed to other brain or brainstem injuries, without investigation of the cervical spinal cord. [29][30][31][32][33][34][35] Fourth, in the setting of suspected BD, the spinal cord is rarely investigated or suspected to be affected when testing for limb movement to pain or apnea. [4][5][6][7][8][9][10][11] A final reason is that most patients are imaged with a CT scan of the brain, and this is often not adequate to show cerebellar herniation, and not inclusive of the upper cervical spinal cord.…”

Section: Discussionmentioning

confidence: 99%

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Brain death and the cervical spinal cord: a confounding factor for the clinical examination

2009

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Study design: This study is a systematic review. Objectives: Brain death (BD) is a clinical diagnosis, made by documenting absent brainstem functions, including unresponsive coma and apnea. Cervical spinal cord dysfunction would confound clinical diagnosis of BD. Our objective was to determine whether cervical spinal cord dysfunction is common in BD. Methods: A case of BD showing cervical cord compression on magnetic resonance imaging prompted a literature review from 1965 to 2008 for any reports of cervical spinal cord injury associated with brain herniation or BD. Results: A total of 12 cases of brain herniation in meningitis occurred shortly after a lumbar puncture with acute respiratory arrest and quadriplegia. In total, nine cases of acute brain herniation from various non-meningitis causes resulted in acute quadriplegia. The cases suggest that direct compression of the cervical spinal cord, or the anterior spinal arteries during cerebellar tonsillar herniation cause ischemic injury to the cord. No case series of brain herniation specifically mentioned spinal cord injury, but many survivors had severe disability including spastic limbs. Only two pathological series of BD examined the spinal cord; 56-100% of cases had upper cervical spinal cord damage, suggesting infarction from direct compression of the cord or its arterial blood supply. Conclusions: Upper cervical spinal cord injury may be common after brain herniation. Cervical spinal cord injury must either be ruled out before clinical testing for BD, or an ancillary test to document lack of brainstem blood flow is required in all cases of suspected BD. BD may not be a purely clinical diagnosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Brain death and the cervical spinal cord: a confounding factor for the clinical examination

2009

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“…It has been under discussion for decades, originating from anecdotic cases, whether LP is associated with brain stem compression precipitating a life-threatening situation when performed in patients with increased ICP (6)(7)(8)(9)(10). An outcome study from our hospital of severe meningitis showed that in most patients developing brain stem symptoms, these appeared shortly after LP (11).…”

Section: Introductionmentioning

confidence: 99%

“…An important reason why no consensus has been reached regarding the use of LP in patients with suspected raised ICP is that no reliable scientific studies on potential adverse effects with LP have been made. As a matter of precaution, some authors recommend that LP should be avoided in patients with clear signs of raised ICP, such as progressive loss of consciousness, agitation and motor anxiety, increasing blood pressure, pupil abnormalities and other focal neurological signs (8,9,11). LP is, however, frequently used in clinical practice also in risk patients (13).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

Grände

2005

Acta Anaesthesiol Scand

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Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture -a physiological approach.Grände, Per-Olof 619-626. DOI: 10.1111619-626. DOI: 10. /j.1399619-626. DOI: 10. -6576.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Methods: Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify haemodynamic effects of distal opening of the spinal canal. Results Conclusion:The present study strongly suggest that post-spinal headache and brain stem compression and other LP-related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.

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Cervicomedullary Injury After Pneumococcal Meningitis With Brain Edema

Muralidharan

Rabinstein²,

Wijdicks

2011

Arch Neurol

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Cerebral herniation during bacterial meningitis in children.

Abstract: Objective-To see whether the incidence of cerebral herniation is increased immediately after lumbar puncture in children with bacterial meningitis and whether any children with herniation have normal results on cranial computed tomography.Design

Cited by 172 publications

References 7 publications

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

Brain death and the cervical spinal cord: a confounding factor for the clinical examination

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

Cervicomedullary Injury After Pneumococcal Meningitis With Brain Edema

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