The incidence and outcome of neurological complications occurring during the acute stage of aseptic meningitis in 277 infants under 2 years of age are reported from Johns Hopkins University, Baltimore, and Dartmouth Medical School, Lebanon, NH. The dominant clinical findings were fever (88%) and irritability (78%). Meningeal irritation occurred in only 8.7%, and 8 (2.9%) infants had a single generalized seizure. Among 52 with neurologic abnormalities, 17 had a full fontanelle, 6 had complex seizures, 2 a large head circumference, and 2 diminished consciousness. Infants older than 3 months had more complications than younger infants. The type of enterovirus (Coxsackie or echo) and CSF indices were not correlated with risk of complications. Infants with CNS complications showed no sequelae on follow-up neurodevelopmental tests. [1]
COMMENT. Acute “encephalitic” complications occurring in approximately 10% of young infants with aseptic meningitis are not associated with long-term neurologic or cognitive deficits.
Straussberg R and associates, at the Hasharon Hospital, Petach Tikvah, Israel, report two young children with posterior fossa tumors who presented with aseptic meningoencephalitis [2]. Somnolence, stupor, and extreme nuchal rigidity were the major manifestations on admission. CSF showed pleocytosis and cultures were sterile. Surgical removal of the tumors revealed a fourth ventricle choroid plexus papilloma and a medulloblastoma. Head CT might avoid the dangers attending lumbar puncture in children with clinical manifestations that are common to both meningitis and posterior fossa tumor.