A 1-year-old treated for Haemophilus influenzae type b meningitis improves initially, then on day 5 develops recurrent fever and a bulging fontanelle with a seizure. CT head shows a crescentic extra-axial collection over the convexity. What is the most likely complication?

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

Explanation

Subdural effusion classically complicates bacterial meningitis in infants, especially with Haemophilus influenzae type b, presenting days into treatment with renewed fever, vomiting, seizures, or a bulging fontanelle. Imaging shows a crescentic fluid collection over the cerebral convexity. Most sterile effusions resolve spontaneously and need no drainage; aspiration is reserved for large collections with mass effect or infected (empyema) collections. D brain abscess is ring-enhancing and rounded, and hydrocephalus produces ventricular dilation rather than a convexity collection.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.