INTRACRANIAL INFECTIONS

These include;

  • Osteomyelitis of the skull commonly complicating penetrating injuries
  • Post craniotomy infections
  • Intracranial infections complicating otitis media
  • Mastoiditis
  • Paranasal sinusitis
  • Scalp infections.

Conditions that may arise from infections

  • Skull osteomyelitis
  • Extradural
  • Subdural empyema
  • Cerebral abscess
  • Meningitis.

Clinical Features

Clinical features will vary depending on the site and spread of infection but will include;

  • Local tenderness
  • Focal neurological signs
  • Disordered consciousness
  • Epilepsy
  • Signs of meningitis.

Diagnosis is made on the basis of clinical history and physical and neurological examination. Plain radiographs of skull may show opaque air sinuses or air bubbles in brain. Angiography or CT scan is used to confirm the diagnosis.

Management

  • Adequate dose of appropriate antibiotics
  • Drainage (multiple burr holes, craniotomy, etc.)
  • Excision of infected bone
  • Drainage of infected sinuses or mastoid air cells
  • Take specimens for culture and sensitivity. Commence antibiotic treatment.
  • Make sure results are traceable
  • Long-term anticonvulsant therapy – phenobarbitone 60–100mg OD with maximum of 180mg, for children 5–8mg daily. Phenitoin 3–4mg/kg daily either as a single dose or 2 divided doses, for children 5mg daily in 2 divided doses and maximum 300mg daily.
  • Arrange and/or provide rehabilitation as needed