Indications et apport de l'echographie transfontanellaire dans le diagnostic et la surveillance des complications neurologiques des meningites [a propos de 48 cas]

ABSTRACT

Having been displayed during one year, this prospective work has fixed the aim of tracking down the meningitis complications and to evaluate the contributions and validity of the transfontanellar ultrasound [TFU] in diagnostic and supervising the neurologic complications of this affection. In 1985, Among the 141 children hospitalized in infectious disease departement [P.1.] 48 children less than 2 years old presenting some signs of gravity, have benefited from 91 T.F.U. The echographic exploration is normal in 58% of the cases. The echographic signs during the sharp phase of the disease are transitory. The T.F.U. has visualized 34 complications distributed in 14 hydrocephalus, 12 ventriculitis, 5 abscesses, 3 subdural hematomas and one case of cerebral tuberculosis. Apart from its diagnostical contribution, the T.F.U. also allows the appreciation of the therapeutic efficacy and the consistency of the evolution of different complications. Certain of our patients whom were submitted to computed tomography [C.T.] made it possible for us to make the correlation T.F.U./C.T. this latter being the examination reference. Thus, we have noticed a kind of superiority of the T.F.U. in the supervising and appreciation of the evolutivity in the ventricular dilatations,and the visualization of the ventriculitis either isolated or associated to abscesses. The C.T. on the contrary is more performant than the T.F.U. in the study of the cerebral tuberculosis, the visualization of the transudation witnessing the hydrocephalus evolutivity, the appreciation of the lesion multiplicity, the research of oedema in cerebral abscess, the visualization of subdural collections. These two techniques have the same performance in the study of ventricular dilatation in the appreciation of the site of obstruction, the effect of the mass and the ventricular dilatation in cerebral abscesses. The T.F.U. contributes equally for the choice of the therapeutic and constitute an excellent method for the follow up, we suggest that the T.F.U. is more recommended in presence of serious clinical signs of gravity and during the neo-natal period where it must be systematic in meningitis because of the lack of anatomoclinic parallelism