An 8-month-old being treated for Haemophilus influenzae type b meningitis initially improves, then on day 5 develops recurrent fever, bulging fontanelle, and focal seizures despite appropriate antibiotics. Neuroimaging is most likely to show:

• A Diffuse cerebral edema with tonsillar herniation
• B Hydrocephalus requiring immediate shunt insertion
• C Cerebral venous sinus thrombosis
• D Subdural effusion ✓

Explanation

Subdural effusion is the most common intracranial complication of H. influenzae type b meningitis in infants, classically presenting with a reappearance of fever, bulging fontanelle, vomiting, or seizures after initial improvement while on effective antibiotics. Most effusions resolve spontaneously; drainage is reserved for those causing mass effect. Hydrocephalus is more typical of tuberculous meningitis, and venous thrombosis and diffuse edema are far less frequent complications.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.