The central nervous system (CNS), comprising the brain and spinal cord, is critical for regulating body activities. In children, CNS diseases pose unique challenges due to ongoing neurological development.

Common conditions include meningitis, encephalitis, and brain abscesses, which may result from infections, trauma, or congenital defects. Paediatric nurses must recognize symptoms, provide care, and educate families to ensure optimal outcomes.

Meningitis

Definition

Meningitis is an acute infection of the meninges, the protective membranes covering the brain and spinal cord, often involving the sub-arachnoid space and causing CNS inflammation.

Types and Characteristics

• Bacterial Meningitis:

  • Causes: Vary by age. Newborns: Group B Streptococcus, Escherichia coli, Listeria monocytogenes. Infants/children: Streptococcus pneumoniae, Neisseria meningitidis.

  • Symptoms: Children: fever, headache, stiff neck, photophobia, confusion, lethargy. Infants: fever, irritability, poor feeding, lethargy.

  • Diagnosis: Lumbar puncture (LP) with cerebrospinal fluid (CSF) analysis (elevated white blood cells, low glucose, high protein), blood cultures.

  • Treatment: Immediate antibiotics (e.g., Ampicillin + cefotaxime for neonates; third/fourth-generation cephalosporin + vancomycin for children).

  • Complications: Neurologic sequelae (e.g., seizures, hearing loss), mortality if untreated.

• Viral Meningitis:

  • Causes: Enteroviruses, herpes simplex virus (HSV-2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), HIV, mumps.

  • Symptoms: Similar to bacterial but milder; includes fever, headache, stiff neck, photophobia.

  • Treatment: Symptomatic (antipyretics, analgesics); Acyclovir for HSV-2.

• Other Types: Tuberculous (treated with isoniazid, rifampin, pyrazinamide, ethambutol, pyridoxine), cryptococcal (Cryptococcus neoformans, treated with Amphotericin B + flucytosine, then fluconazole), histoplasmosis (Histoplasma capsulatum, treated with Amphotericin B, then itraconazole).

Encephalitis

Definition

Encephalitis is an infection or inflammation of the brain parenchyma, predominantly viral, sometimes involving the meninges (meningoencephalitis).

Characteristics

• Causes: HSV-1 (children >3 months, affects temporal/frontal lobes), HSV-2 (neonates, generalized, acquired at delivery), West Nile virus, rabies, mosquito-borne viruses.

• Symptoms: Alteration of consciousness (97%), fever (92%), dysphasia (76%), ataxia (40%), seizures (38%), hemiparesis (38%), cranial nerve defects (32%).

• Diagnosis: CSF analysis, CT/MRI, polymerase chain reaction (PCR), brain biopsy (rare).

• Treatment: Supportive care (airway, breathing, circulation, nutrition, fluid management, monitoring for increased intracranial pressure [ICP] and seizures); antiviral therapy with Acyclovir (10 mg/kg IV every 8 hours for 14–21 days in adults; 20 mg/kg every 8 hours for 21 days in neonates).

Brain Abscess

Definition

A brain abscess is a focal suppurative infection within the brain parenchyma, often encapsulated; early stages may present as cerebritis (nonencapsulated).

Characteristics

• Causes: Direct spread (sinusitis, otitis media, dental infections), head trauma, neurosurgery, hematogenous spread. Pathogens: Streptococci, bacteroides, Staphylococcus aureus, Actinomyces, Nocardia, Candida.

• Symptoms: Fever (58%), headache (55%), disturbed consciousness (48%), hemiparesis (48%), nausea/vomiting (32%), nuchal rigidity (29%), seizures (19%).

• Diagnosis: Lumbar puncture, brain CT/MRI.

• Treatment: Medical for abscesses <3 cm, symptoms <2 weeks, with improvement within 1 week; antibiotics based on culture results. Surgical drainage or excision for larger abscesses or non-responsive cases.

Nursing Considerations

• Assessment: Monitor vital signs, neurological status (Glasgow Coma Scale, pupillary response, motor function, reflexes), and signs of increased ICP (headache, vomiting, altered consciousness, papilledema).

• Care Management: Administer medications (antibiotics, antivirals, anticonvulsants), provide supportive care (hydration, nutrition, pain management, seizure precautions), and follow infection control protocols for infectious diseases.

• Education: Educate parents on prevention (e.g., vaccinations for Hib, pneumococcal, meningococcal; hygiene practices) and recognition of early symptoms.

• Psychosocial Support: Offer emotional support to children and families, facilitate communication with specialists (e.g., neurologists, infectious disease experts).

• Monitoring and Documentation: Record neurological changes, vital signs, fluid intake/output, and medication administration accurately.