The ultrasonographic diagnosis of bacterial meningitis and ventriculitis in infancy: six case reports.

Five infants with meningitis and ventriculitis, and a sixth patient with meningitis only are reported. In one hydrocephalic infant, infection of the central nervous system (CNS) was not suspected until cerebral ultrasonography revealed features of ventriculitis. It appears that in non-communicating hydrocephalus managed with a ventriculo-peritoneal (VP) shunt, infection may involve predominantly the "sequestered ventricles" rather than the spinal meninges. In four infants, bacterial meningitis had been proven but ventriculitis was not diagnosed until cerebral ultrasonography was performed. In a sixth neonate, E coli Kl meningitis was diagnosed and treated very early and cerebral ultrasonography showed involvement of the surface of the brain, but not the ventricles. The ultrasonographic features of bacterial ventriculitis and meningitis in infancy are: Increased echogenicity of the ventricular fluid, either in a fine homogeneous pattern, or with strand-like material and coarse particles. Increased echogenicity of the ependymal lining of the ventricles. Loss of definition of the surface of the choroid plexuses. Hydrocephalus, which may be progressive, with or without loculation of fluid. Abnormally wide and prominent cerebral sulci as a sign of meningitis. With treatment, the ventricular fluid became normal in a few days. The other abnormalities resolved more slowly. Hydrocephalus and fluid loculation were slowest to resolve. Ultrasonography has the potential for recognition of other complications such as subdural fluid collections and cerebral abscess.