Acute leptomeningitis in children: its prognosis and sequelae
Thatcher, Lewis Hay Frederick
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In selecting this ,subject for a Thesis, I was influenced by the fact that, although much work has been done recently on the Diagnosis and Treatment of the various forms of Leptomeningitis, considerably less attention has been paid to the after effects thereof; for this disease, if not Immediately fatal, exhibits a marked tendency to leave a residue of ill effects in the form of various deformities, which may or may not be ultimately recovered from.Complications during the acute stage of the illness only, i.e. Paralysis or spasm of muscles, Metastatic abscesses, Epistaxis, Irido- cyclitis, etc. are not dealt with, but only the which remain after convalescence from the original Meningeal Inflaiimation.Naturally, such investigation must be to a large extent clinical, in that very few of the cases followed up and examined at intervals are available Post Mortem, in order to trace the seat and nature of the lesion causing the Sequela. On the other hand, examinations on fatal cases frequently spew lesions which might quite well be responsible for any given Sequela, and together spewing the latter to be dependant, roughly, on three facts: -(1) Fibrous thickening and consequent scar contraction of a previously acutely inflamed Membrane, also, probably invariably, involvin the subjacent brain tissue itself.(2) Compression of brain tissue by an acquired Internal Hydrocephalus.(3) That all cranial nerves and vessels are surrounded by lymph channels directly continuous with the Subarachnoid space, thus facilitating the spread of any infective process from this area along then.I may mention here that I have been unable to find definite records of any sequela brought on experimentally in animals, the subject being either killed outright by the intra -spinal injection of organisms, or else being completely unaffected. Courtellenent mentions a case of a dog which develope an acute, rapidly fatal, ascending paralysis four months after injection of this sort with Meningococci,' although it chewed no sign of Meningitis at time of inoculation.Most of statistics and cases noted were obtained from the Casebooks of the Royal Hospital for Sick Children, Edinburgh, for about the last 10 years. The parents of 42 children discharged either "Cured" or "Relieved" were written to. Of these 29 answered, and 23 children were brought up for examination, either once or repeatedly. In addition, particulars were obtained of the progress of 4 others, and also 12 cases which cane up for treatment or advice during ray terr_i of House Physician are dealt with, including all those of Meningis :m described.Cases removed to the City Fever Hospital were followed up in the Casebooks there.I went over the records in the Royal Deaf and Dumb Institution, and also in Donaldson's Hospital for Deaf and Dumb, Edinburgh, and saw all the cases at present under tuition in both these Schools.It will be seen that all the cases of the Tuberculous ,. , Pneuenocacoal, and Septic varieties were fatal: all the cases described as suffering from Sequelae were discharged after Cerebrospinal Meningitis of Meningococcic origin, either Epidemic or Sporadic, and I shall give a brief resumé of the points on which the presumption is based that these are only slightly modified forms of the same disease.Naturally in the earlier cases, before the present refinements of diagnosis arose, there may have existed a certain doubt as to the true nature of the case. I went over, and carefully annotated, the notes of each, and excluded all those in which there was not sufficient evidence, either Clinical or Bacteriological to bear out the Diagnosis.