A fetal case of acute meningitis in a child is reported to illustrate the orderly sequence of neurological signs indicating progressive brainstem compression, leading to death. The similarity of this neurological pattern to that seen in patients with supratentorial mass lesions is emphasized.
Six cases of acute meningitis in infants and children are then reported who similarly showed signs of progressive brain swelling and herniation, in whom intravenous urea was used in treatment. In two children who were felt to be moribund with bulging anterior fontanel, coma, poorly reactive pupils, deteriorating respirations, and convulsions, the response to the infusion of urea was dramatic, with improvement in consciousness, respirations, and pupillary signs, and cessation of convulsions. Two other children had a less dramatic response to urea, but were definitely improved. Two were thought to have had possible benefit. No child showed deleterious effects from treatment with urea.
The mechanism of action of osmotic agents in the treatment of brain swelling is discussed. Hypertonic intravenous urea was felt to have been a safe and possibly valuable adjunct to the therapy of the patients of this study.