International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
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Case Report

Volume 4, Number 1, March 2015, pages 127-136

Group B Streptococcal Meningitis: A Description of Six Case Reports

Figures

Figure 1.
Figure 1. Echogenic widening of brain’s sulci and interhemispheric fissure associated with meningeal thickening; mild ventricular enlargement.
Figure 2.
Figure 2. Brain MRI: bilateral asymmetrical subdural effusions, prevalent on the right side of the brain.
Figure 3.
Figure 3. Parasagittal section: multiple echodensities of the left caudate.
Figure 4.
Figure 4. Parasagittal section: multiple echodensities of the caudate head.
Figure 5.
Figure 5. Coronal section: bilateral echodensities of the caudate and of the right periventricular white matter.
Figure 6.
Figure 6. MRI: multiple and confluent ischemic areas (B-C) in the basal ganglia and frontal periventricular white matter.
Figure 7.
Figure 7. Echogenic widening of brain sulci and interemispheric fissure.
Figure 8.
Figure 8. MRI: biconvex subdural effusions (A-E); strand formation within the lateral ventricles (D-E); ischemic foci in the basal ganglia (C, F); bilateral frontal periventricular ischemic areas (E).
Figure 9.
Figure 9. Abnormal resistance index (RI = 0.35).
Figure 10.
Figure 10. Parasagittal section: frontal periventricular echodensity (red arrow).
Figure 11.
Figure 11. Coronal section: asymmetric widening of lateral ventricles; single and localized echodensity in the left thalamus (black star).
Figure 12.
Figure 12. Coronal section: asymmetric widening of lateral ventricles; intraventricular strand (red arrow); localized echodensity in the left thalamus (black star).
Figure 13.
Figure 13. Median parasagittal section: widening of the left lateral ventricle and localized echodensity in the left thalamus (red arrow).
Figure 14.
Figure 14. Left parasagittal image: widening of lateral ventricle with a septum inside (red arrow) and localized echodensities of anterior thalamus.
Figure 15.
Figure 15. Coronal section: asymmetric widening of lateral ventricles.
Figure 16.
Figure 16. Coronal section: asymmetric widening of lateral ventricles; intraventricular strand; localized echodensity in the left thalamus.
Figure 17.
Figure 17. Coronal section: widening of the lateral ventricles and hyperechoic basal ganglia.
Figure 18.
Figure 18. Sagittal section: severe widening of the left lateral ventricle and hyperechoic basal ganglia.
Figure 19.
Figure 19. MRI: Movement artfacts. Bilateral multiple extensive cysts in the fronto-parietal white matter and focal bilateral emorrhages of lenticular nucleus. Obstructive triventricular hydrocephalus.
Figure 20.
Figure 20. Normal resistance index (IR) but evidence of increased telediastolic velocity.
Figure 21.
Figure 21. Coronal section: mild widening of interhemispheric fissure with subarachnoid echogenic strands.
Figure 22.
Figure 22. Coronal section: echogenic widening of posterior interhemispheric fissure.
Figure 23.
Figure 23. Coronal section: asymmetric lateral ventricles; rounded echodensity in the left thalamus (arrow) and incipient cavitation of both left caudate nucleus and thalamus (star).

Table

Table 1. Summary of Six Cases of GBS Meningitis
 
PatientsEG (weeks)/PN (g)Sex/ageClinical findingsUSMR/CTOutcome
132/1,450F/2 monthsSeptic status, fever, high-pitched cry, bregmatic fontanel bulging, nuchal rigidity, SIADHDiffuse thickening of the leptomeningesFrontal bilateral subdural effusionsCollections drainage; no global delay at 3 years of age
239/3,360F/4 daysFeeding intolerance, fever, seizure, hypotoniaEdema, hydrocephalus, bilateral frontal cystsVentriculitis; bilateral basal ganglia and frontal ischemic lesions evolving in cystsNo global delay at 1 and 3 months of age
332/2,150F/38 daysFeverBilateral subdural empyemaBilateral subdural empyema, dural thrombosis of the left transversal sinusEmpyema drainage; no global delay at 3 years of age
438/2,280F/3 daysFever, feeding intoleranceEdema, obstructive triventricular hydrocephalus, bilateral frontal cystsFrontal and parietal white matter cysts, abnormal signal of frontal, parietal and deep gray matter (putamen and pallidus)Increased muscle tone at 50 days of age
539/3,190M/1 dayFever, pale cianosis, hyperreactivityBilateral hyperecoic basal ganglia, interhemispheric fissure and subarachnoid spaceTransversal sinus thrombosis, small cortical hemorrhages with basal ganglia involvement; ischemis of frontal subcortical white matter bilaterallyMild motor delay; convergent strabismus at 19 months of age
639/3,070F/30 daysFever, feeding intoleranceHyperechoic sulciNot performedExitus