Postinfectious Hydrocephalus in Children

Advances and Technical Standards in Neurosurgery

“…A recent study on very low birth weight neonates with meningitis identified coagulase-negative staphylococci as the most common cause (43% of episodes), followed by other gram-positive bacteria (19%) and gram-negative bacteria (17%) (Doctor et al 2001). The incidence of postinfective hydrocephalus in this specific subset of patients ranges between 50% and 75% (Ciurea et al 2004). It usually occurs within 2-3 weeks following the initial diagnosis, but it may develop months or years after the acute phase of the disease.…”

“…However, the occurrence rate of hydrocephalus in these children is relatively low (10-15%) (Ciurea et al 2004). In most cases an extensive involvement of the cerebral structures takes place leading to a di¤use encephalomalacia and consequent ex vacuo ventricular dilatation.…”

“…In acute cases extensive necrosis of the cerebral hemispheres can be observed with associated significant cerebral tissue loss, which contributes to the ventricular enlargement. Most authors consider post-toxoplasmosis hydrocephalus a consequence of severe leptomeningeal inflammation blocking the subarachnoid spaces (Kaiser 1985, Ciurea et al 2004). However, a significant percentage of these children present with purely triventricular hydrocephalus.…”

“…However, hydrocephalus in these patients is uncommon occurring in less than 10% of the cases (Daoud et al 1998). One of the hypothesis for this low rate is that Haemophilus B ventriculitis usually causes choroid plexuses atrophy, with consequently reduced CSF production (Ciurea et al 2004). In contrast with Gram negative CSF infections, viral ventriculitis are frequently followed by the development of hydrocephalus.…”

“…In contrast with Gram negative CSF infections, viral ventriculitis are frequently followed by the development of hydrocephalus. Viruses inclusions cause granular ependymitis and ependimal cell loss or fusion; this process frequently involves the Sylvian aqueduct leading to secondary aqueductal stenosis; however, some authors have pointed out that the damaged ependyma itself may contribute to this process because of the secondarily induced reduction in CSF transportation and replacement (Ciurea et al 2004). In non endemic countries hydrocephalus, secondary to tuberculous meningitis is a rare occurrence.…”