Don't Think Meningitis First in Status Epilepticus

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Meningitis was a rare cause of status epilepticus (SE) in this retrospective single-center review.

Why does this matter?
Meningitis or encephalitis is in the differential diagnosis (ddx) when a child presents with SE.  This study shows that meningitis or encephalitis is an extremely rare cause.  It should remain in the differential diagnosis, but other causes should be considered first.

What's the status?
This was a retrospective review of all children presenting to a single center over approximately 17 years with SE.  Of children with SE, 126 had a LP performed.  Of these, 8 had positive CSF pleocytosis; 5 had been pretreated with antibiotics.  Only one had confirmed bacterial meningitis (0.8%).  13 were tested for enterovirus, and 2 were positive.  47 were tested for HSV, and 1 was positive.  The study was limited by the retrospective design and the high number of patients who were pretreated with antibiotics prior to LP, which may have falsely reduced the number with bacterial meningitis. However, the most conservative estimate sets a maximum rate of bacterial meningitis at 2.4%.  Thomas said, "are you willing to miss up to 2.4% of cases of bacterial meningitis as the current study suggests in its conservative estimate? Seems like missing bacterial meningitis is a worse diagnosis to miss than a 2% miss rate for MI."

Source
Utility of Lumbar Puncture in Children Presenting With Status Epilepticus.  Pediatr Emerg Care. 2017 Jul 11. doi: 10.1097/PEC.0000000000001225. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.