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Subdural effusion following infantile meningitis

Case contributed by Joseph Scheller
Diagnosis certain

Presentation

Toddler with irritability and vomiting. Admitted 7 weeks prior with high fever and lethargy. Lumbar puncture then demonstrated streptococcus pneumoniae.

Patient Data

Age: 1 year
Gender: Male

Large bilateral isodense extra axial collection with mass effect on the brain's surface bilaterally, poor visualization of sulci and gyri. Mildly enlarged third ventricle. Small focus of acute extra axial hemorrhage in the right parietal extra axial collection.

Ten days following the previous scan. There is now a right subdural shunt tube. The extra-axial fluid collection is smaller and there is improved visualization of the brain's surface. There is a bifrontal subdural membrane with foci of acute subdural hemorrhage along the membrane. The enlarged third ventricle is unchanged.

Case Discussion

This is a subdural effusion that developed as a complication of bacterial meningitis. The neurosurgeon drained the fluid collection shortly after the first head CT and noted dark yellow fluid, analysis revealed a high protein content. The child did well post-operatively.

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