Magnetic resonance imaging and dexamethasone therapy for bacterial meningitis
M. H. Lebel, M. J. Hoyt, D. C. Waagner, N. K. Rollins, T. Finitzo and G. H. McCracken Jr
Department of Pediatrics, University of Texas Southwestern Medical Center, Southwestern Medical School, Dallas.
We conducted a third placebo-controlled, double-blind study of
dexamethasone as adjunctive therapy for bacterial meningitis. Thirty-one
patients received cefuroxime sodium (300 mg/kg per day in 3 doses) and
dexamethasone phosphate (0.6 mg/kg per day in 4 doses for 4 days), and 29
received cefuroxime and placebo. The groups were comparable at the
beginning of therapy. Magnetic resonance imaging performed between days 2
and 5 of therapy was used to assess brain water content indirectly. There
were no differences between the 2 treatment groups with respect to the T1-
or T2-weighted images. Fifty-two patients (88%) had normal magnetic
resonance images; 5 patients had parietal or bifrontal extra-axial fluid
collections, and 2 children had areas of abnormal signal intensity in the
brain on T2-weighted images. Abnormal findings on magnetic resonance
imaging did not alter clinical management, and there was no correlation
between the results of magnetic resonance imaging and the outcome of
meningitis. The number of patients in this study was too small to determine
any statistically significant differences in rates of hearing impairment;
however, the cerebrospinal fluid findings and clinical outcome in
dexamethasone-treated patients further support the previously reported
beneficial effect of corticosteroid treatment in patients with bacterial
meningitis.
