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Acute bacterial meningitis is a sudden, potentially fatal infection that affects the membranes covering the brain and spinal cord, and may result in permanent disability. Drugs that kill bacteria, called antibiotics, are used to treat acute bacterial meningitis; it is crucial that the right antibiotic be administered in the proper dose for an adequate period of time. For example, infection with bacteria belonging to group B streptococcus are most effectively treated with penicillin G in a dose of 60 to 120 milligrams/kilogram/day in four doses, which are administered intravenously (IV). After being treated for 48 to 72 hours, a possible complication of acute bacterial meningitis is inflammation of the ventricles of the brain; treatment may involve administering antibiotics directly into the ventricles. Other complications include seizures, which may be treated with IV phenytoin (dilantin). If fluid accumulates on the brain (hydrocephalus), it may be drained by the insertion of a tube called a shunt. It is imperative that the shunt not become infected; consequently, antibiotics are often given during the insertion, replacement, or removal of a shunt. In conclusion, bacterial meningitis is a serious condition that warrants close monitoring and aggressive antibiotic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

The diagnosis of meningitis in children is generally not difficult. The fever and stiff neck are characteristic signs; sometimes the patient is admitted in a coma. If the child does not show signs of increased intracranial pressure or have coagulation defects, a lumbar puncture should be performed to identify the causative organism when meningitis is suspected. The diagnosis in infants is slightly more complicated, although cases invariably show the standard indications of infection, fever or hypothermia, lethargy interspersed with irritability, jaundice, vomiting, diarrhea, and respiratory distress. Generally, a lumbar puncture should be routinely performed to determine if infectious organisms are present in the cerebrospinal fluid. In cases of meningitis, there is a 90 percent chance of isolating and identifying the causative organism in blood culture. Commercially available antibody test kits may be obtained for Haemophilus influenzae type B, Streptococcus pneumoniae, Neisseria meningitidis groups A, C, Y, and W135, K1 strains of E. coli, group B streptococci, Listeria monocytogenes, Klebsiella pneumonia, and Pseudomonas aeruginosa. Of course, at the same time the organism is identified, its antibiotic sensitivity may be determined. If antibiotic therapy is begun within 24 hours of the onset of symptoms, the recovery is likely to be good, but delay may result in serious illness and the risk of death. Since the cerebrospinal fluid may be negative early in infection, the failure to identify bacteria does not rule out bacterial meningitis, and a repeat lumbar puncture should be made, whether or not treatment has begun. (Consumer Summary produced by Reliance Medical Information, Inc.)

Schizencephaly is a brain abnormality characterized by the presence of fissures (clefts) in one or both of the cerebral hemispheres. There are two types, one in which the lips of the fissures are fused and one in which the lips remain separated. Complications associated with schizencephaly include spastic quadriplegia, convulsions, and mental retardation. Previously, schizencephaly has been thought to be caused by some random event during pregnancy, but not by hereditary factors. This study examined the cases of two infants, a brother and sister, who were born with identical types of schizencephaly. The first case involved a female born in 1973. She began to exhibit symptoms of spastic quadriplegia at 3 months of age and experienced convulsions at 17 months. She had moderate problems with learning. Her brother was born in 1979. He began showing symptoms of spastic quadriplegia at four weeks of age. Convulsions occurred at age seven years. He had moderate learning difficulties and severe growth retardation. In both cases, the schizencephaly was bilateral and open-lipped. These results indicate that a possible genetic cause may exist for this disorder and that parents who have a child with this disorder should receive genetic counseling. (Consumer Summary produced by Reliance Medical Information, Inc.)