Does computed tomography have a role in the evaluation of complicated acute bacterial meningitis in childhood?

The authors examined the records of 30 children with bacterial meningitis to review the role of computed tomography (CT) of the brain in acute management of the disease. CT was normal for 10 patients, six of whom had clinical evidence of raised ICP. CT identified an underlying surgical abnormality in two patients with progressive focal neurological signs. One patient had unsuspected gross hydrocephalus diagnosed by CT, which required neurosurgery. This study shows that the management of bacterial meningitis is influenced by CT in only a minority of cases; for patients with clinical signs of raised ICP, it was found to be insensitive in confirming the clinical diagnosis and establishing an underlying cause. However, CT remains valuable in the management of children with progressive neurological signs for whom neurosurgical intervention may be necessary.