Accès libre

Bacterial meningitis in neonates and infants – the sonographic picture

Błażej Littwin
Błażej Littwin
, 
Andrzej Pomiećko
Andrzej Pomiećko
, 
Monika Stępień-Roman
Monika Stępień-Roman
, 
Zeno Spârchez
Zeno Spârchez
 et 
Wojciech Kosiak
Wojciech Kosiak
   | 30 mars 2018
Journal of Ultrasonography's Cover Image
À propos de cet article
Article précédent
Article suivant
Citez
Article Category: review-article
Publié en ligne: 30 mars 2018
Pages: 63 - 70
Reçu: 03 juil. 2017
Accepté: 29 août 2017
DOI: https://doi.org/10.15557/jou.2018.0010
Mots clés
© 2018 Błażej Littwin et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

A. Imaging through the anterior fontanelle shows widening of the sulcus pattern of the brain gyri and elevated echogenicity of the space between the sulci (arrow). B. A higher echo is seen in the extra-axial space in the longitudinal plane
A. Imaging through the anterior fontanelle shows widening of the sulcus pattern of the brain gyri and elevated echogenicity of the space between the sulci (arrow). B. A higher echo is seen in the extra-axial space in the longitudinal plane

Fig. 2

Thickening of the pia mater and the adjacent arachnoid – the leptomeninges layer
Thickening of the pia mater and the adjacent arachnoid – the leptomeninges layer

Fig. 3

A. Color Doppler imaging shows increased flow in the superficial cerebral vessels. In the superior sagittal sinus flow constriction associated with the presence of a parietal thrombus (arrows) is seen. B. Imaging through the anterior fontanelle in the longitudinal plane. One of the perforator veins is dilated with a surrounding hyperechoic extra-axial echo. A vessel partly covered by the color Doppler gate with a visible ostium into the superior sagittal sinus (star) is seen
A. Color Doppler imaging shows increased flow in the superficial cerebral vessels. In the superior sagittal sinus flow constriction associated with the presence of a parietal thrombus (arrows) is seen. B. Imaging through the anterior fontanelle in the longitudinal plane. One of the perforator veins is dilated with a surrounding hyperechoic extra-axial echo. A vessel partly covered by the color Doppler gate with a visible ostium into the superior sagittal sinus (star) is seen

Fig. 4

A three-month-old infant with purulent BM caused by E. coli. Imaging through the anterior fontanelle in the transverse plane: A. widening of the subdural space on the left side with a normal image of the subarachnoid space; B. a follow-up examination of the patient during fever increase after 2 days. Widening of the subarachnoid space with increased echogenicity due to the accumulation of inflammatory exudate (the subarachnoid space is marked with an arrow in the images)
A three-month-old infant with purulent BM caused by E. coli. Imaging through the anterior fontanelle in the transverse plane: A. widening of the subdural space on the left side with a normal image of the subarachnoid space; B. a follow-up examination of the patient during fever increase after 2 days. Widening of the subarachnoid space with increased echogenicity due to the accumulation of inflammatory exudate (the subarachnoid space is marked with an arrow in the images)

Fig. 5

A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. The evolution of changes during treatment monitoring is presented. A. Imaging through the anterior fontanelle shows subdural hygromas. B. A subdural empyema (longitudinal sections on the left, transverse sections on the right). Echogenic fibrin structures forming separate fluid cavities. Color Doppler imaging shows no vascular flow in the fibrin structures. C. MRI: subdural empyema on the left side, on the surface of the frontal lobes, with signs of impression on brain tissue
A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. The evolution of changes during treatment monitoring is presented. A. Imaging through the anterior fontanelle shows subdural hygromas. B. A subdural empyema (longitudinal sections on the left, transverse sections on the right). Echogenic fibrin structures forming separate fluid cavities. Color Doppler imaging shows no vascular flow in the fibrin structures. C. MRI: subdural empyema on the left side, on the surface of the frontal lobes, with signs of impression on brain tissue

Fig. 6

A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. A. A closed fluid space following subdural empyema treatment. Color Doppler imaging shows no flow in the space. B. Follow-up: gradual regression of the fluid cavity. Notable widening of the subarachnoid space with normal echogenicity (arrows)
A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. A. A closed fluid space following subdural empyema treatment. Color Doppler imaging shows no flow in the space. B. Follow-up: gradual regression of the fluid cavity. Notable widening of the subarachnoid space with normal echogenicity (arrows)

Fig. 7

A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. Due to the lack of clinical improvement when using triple combination antibiotic therapy (cefotaxime/amikacin/ vancomycin) it was decided to administer a drug directly into the empyema area by anterior fontanelle puncture. The images show the puncture needle end in the transverse and longitudinal planes. Gentamicin was administered into the empyema cavity and approximately 60 ml of pus fluid was drained
A three-and-a-half-month-old infant with diagnosed BM caused by E. coli. Due to the lack of clinical improvement when using triple combination antibiotic therapy (cefotaxime/amikacin/ vancomycin) it was decided to administer a drug directly into the empyema area by anterior fontanelle puncture. The images show the puncture needle end in the transverse and longitudinal planes. Gentamicin was administered into the empyema cavity and approximately 60 ml of pus fluid was drained

Fig. 8

A twenty-six-day-old infant with diagnosed BM caused by Streptococcus agalactiae. In the course of the therapeutic process the diagnostic examination of the coagulation system was extended and concomitant protein S deficiency was diagnosed. Low-molecular-weight heparins were used for treatment. A. On the left, imaging through the anterior fontanelle reveals a normal image of the superior sagittal sinus. A susceptible to pressure, triangular lumen of the vessel is notable. On the right, a round section of the superior sagittal sinus which is not susceptible to delicate pressure of the transducer is seen (arrow). If no thrombus is visualized using standard viewing planes, such an image can suggest that thrombosis is present in a segment of the vessel which is not accessible to scanning. B. Parietal thrombus in the superior sagittal sinus visible in transverse and longitudinal planes in B-mode and color Doppler. C. MRI: visible signs of disseminated coagulation in the cerebral venous system including superficial vessels, deep vessels (straight sinus – arrow) and the confluence of sinuses
A twenty-six-day-old infant with diagnosed BM caused by Streptococcus agalactiae. In the course of the therapeutic process the diagnostic examination of the coagulation system was extended and concomitant protein S deficiency was diagnosed. Low-molecular-weight heparins were used for treatment. A. On the left, imaging through the anterior fontanelle reveals a normal image of the superior sagittal sinus. A susceptible to pressure, triangular lumen of the vessel is notable. On the right, a round section of the superior sagittal sinus which is not susceptible to delicate pressure of the transducer is seen (arrow). If no thrombus is visualized using standard viewing planes, such an image can suggest that thrombosis is present in a segment of the vessel which is not accessible to scanning. B. Parietal thrombus in the superior sagittal sinus visible in transverse and longitudinal planes in B-mode and color Doppler. C. MRI: visible signs of disseminated coagulation in the cerebral venous system including superficial vessels, deep vessels (straight sinus – arrow) and the confluence of sinuses

Fig. 9

On the left, asymmetrical dilation of the ventricular system is seen. On the right: a 7-month-old patient with BM caused by E. coli complicated with Candida infection. Visible signs of hydrocephalus with the dilation of the temporal horns of the lateral ventricles (arrows)
On the left, asymmetrical dilation of the ventricular system is seen. On the right: a 7-month-old patient with BM caused by E. coli complicated with Candida infection. Visible signs of hydrocephalus with the dilation of the temporal horns of the lateral ventricles (arrows)

Fig. 10

A. Acute phase of cortical infarction in the frontal gyri. A hypoechoic area without a visible flow in color Doppler with a surrounding hyperechoic area of reaction (on the left – transverse sections, on the right – longitudinal sections). B. Areas of subcortical leukomalacia. Color Doppler imaging shows no vascular flow in the visualized changes (on the left – transverse section, on the right – longitudinal section)
A. Acute phase of cortical infarction in the frontal gyri. A hypoechoic area without a visible flow in color Doppler with a surrounding hyperechoic area of reaction (on the left – transverse sections, on the right – longitudinal sections). B. Areas of subcortical leukomalacia. Color Doppler imaging shows no vascular flow in the visualized changes (on the left – transverse section, on the right – longitudinal section)

Fig. 11

Compartmentalization of the ventricles. A visible septum in the central part of the left lateral ventricle
Compartmentalization of the ventricles. A visible septum in the central part of the left lateral ventricle

Fig. 12

A two-and-a-half-month-old infant with diagnosed BM caused by Streptococcus agalactiae. On the left, a narrow, compressed lumen of the lateral ventricles associated with brain edema is visible. On the right, an elevated RI in the anterior cerebral artery is observed
A two-and-a-half-month-old infant with diagnosed BM caused by Streptococcus agalactiae. On the left, a narrow, compressed lumen of the lateral ventricles associated with brain edema is visible. On the right, an elevated RI in the anterior cerebral artery is observed

Fig. 13

A. Hyperechoic periventricular halo (arrows). A star marks the cavity of the septum pellucidum. B. A well-delimited hypoxic-ischemic lesion in the view of thalamic nuclei on the left side
A. Hyperechoic periventricular halo (arrows). A star marks the cavity of the septum pellucidum. B. A well-delimited hypoxic-ischemic lesion in the view of thalamic nuclei on the left side

Fig. 14

A two-and-a-half-month-old infant with diagnosed BM caused by Streptococcus agalactiae. Infection complicated with aseptic encephalitis. CSF examination revealed signs of protein-cell separation. A. Imaging through the anterior and posterolateral fontanelle shows extensive loss of brain tissue manifesting as malacia cavities and hydrocephalus. B. Follow-up MRI performed directly before discharge from hospital. BM complicated by communicating hydrocephalus with the formation of fluid chambers. Parts of brainstem and cerebellum are visible (arrows)
A two-and-a-half-month-old infant with diagnosed BM caused by Streptococcus agalactiae. Infection complicated with aseptic encephalitis. CSF examination revealed signs of protein-cell separation. A. Imaging through the anterior and posterolateral fontanelle shows extensive loss of brain tissue manifesting as malacia cavities and hydrocephalus. B. Follow-up MRI performed directly before discharge from hospital. BM complicated by communicating hydrocephalus with the formation of fluid chambers. Parts of brainstem and cerebellum are visible (arrows)

Fig. 15

A three-month-old infant with diagnosed BM caused by Streptococcus agalactiae. A. Imaging of the lumbar spine following lumbar puncture. A hyperechoic area of reaction around the spinal cord. Color Doppler imaging shows a rich vascular flow. B. A scan after 5 days of treatment before a planned follow-up puncture: a normal image of neural structures with the perimedullary space is seen
A three-month-old infant with diagnosed BM caused by Streptococcus agalactiae. A. Imaging of the lumbar spine following lumbar puncture. A hyperechoic area of reaction around the spinal cord. Color Doppler imaging shows a rich vascular flow. B. A scan after 5 days of treatment before a planned follow-up puncture: a normal image of neural structures with the perimedullary space is seen
eISSN:
2451-070X
Langue:
Anglais
Périodicité:
4 fois par an
Sujets de la revue:
Medicine, Basic Medical Science, other
RSS Feed de la revue