A 6-month-old infant with bacterial meningitis develops increasing head circumference and a bulging fontanelle despite 10 days of appropriate antibiotics. Transillumination of the skull is positive. What is the most likely complication?

• A Brain abscess
• B Hydrocephalus
• C Subdural effusion ✓
• D Cerebral venous sinus thrombosis

Explanation

Subdural effusion is a common complication of bacterial meningitis in infants, occurring in up to 30% of cases, and is suggested by increasing head circumference, bulging fontanelle, and positive transillumination despite treatment. It is most commonly associated with Haemophilus influenzae and pneumococcal meningitis. Hydrocephalus would present similarly but transillumination is characteristic of subdural collection. Brain abscess and venous sinus thrombosis are less common.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.