Posttraumatic meningitis in adolescents and children.

To define the clinical features of posttraumatic meningitis in the pediatric age group, we have reviewed 7 cases presenting to Children's Hospital-San Diego between 1981 and February 1988. Ages ranged from 3 to 16 years with 4 of the 7 patients being adolescents (greater than 13 years of age). These 4 adolescents accounted for 25% of the adolescent bacterial meningitis and all cases of nonmeningococcal meningitis in this age group. Six of 7 patients had positive cerebrospinal fluid (CSF) cultures and positive blood cultures. Organisms were Streptococcus pneumoniae (4), group A streptococcus (1), and Haemophilus influenzae (1). Five of the 7 patients required intensive cardiovascular and respiratory support. Four patients had a good neurologic recovery, 2 patients had neurologic sequelae, and 1 suffered sensorineural hearing loss. These data suggest that direct invasion of the CSF by bacteria may cause sepsis and cardiovascular compromise. Further, in adolescents with nonmeningococcal bacterial meningitis, a history of previous head trauma and CSF leakage should be sought and radiographic evaluation for CSF fistula should be considered.