CASE PRESENTATION

Post-traumatic meningitis in child

Presented By:-
Dr. Asheesh Babu Patel
(P G Resident 1st year)
10/08/2021
Dept.of Forensic Medicine
& Toxicology
Lt.B.R.K.M.G.M.C. Jagdalpur

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 CONTENTS
• PRILIMINARY DATA
• EXTERNAL EXAMINATION
• INTERNAL EXAMINATION
• Opinion
• Discussions

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 PRILIMINARY DATA

• Age/sex: 3 month/female ; Weight. 5.5kg ; height.

59 cm
• Information stated in police inquest: deceased was
fallen from height of less than one metre from a
home-made swing in home due to breakage of
rope. Victim was admitted in hospital after 7 days in
unconscious state. Glasgow coma scale was
E1V1M2. she died 11 days after incident.
• Information collected from the relatives: victim was
sick and crying more prior to incident and was
conscious after the incident, she became more sick
and visited the hospital after 7 days.
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 EXTERNAL EXAMINATION

Body cold. Rigor mortis absent. postmortem lividity was faint, not fixed,
bluish pink in colour, present over back of trunk and neck. No signs of
decomposition was present. Features natural. No purging. Therapeutic iv
mark present over both hands, both cubital fossa and both ankles. Right
eye partially opened, left eye closed, cornea were hazy, sclera and
conjunctiva were pale of both eyes. Mouth was closed, teeth 0/0. brown
colour crust present in right EAC. No external injury was present except an
abrasion over left iliac crest with linear sparing within sized 3cm*3cm
brown in colour. 4
Right ear Left ear

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 INTERNAL EXAMINATION
1. Cranial cavity:-
- Scalp intact and no under-scalp injury, anterior fontanel is
open, posterior fontanel is closed, no skull fracture was
present at autopsy.
- Meninges intact and pale, greenish yellow discolouration
present. Subarachnoid space and ventricles contains thick
greenish-yellow purulent CSF.
- Brain: 570gm, soft and partially liquified.

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2. Thoracic cavity:-
- Diaphragm, soft tissue and ribs are intact.
- Pleura intact and congested.
- Gross appearance:- both lungs are intact,
congested, right lung – 50 gm, left lung – 35 gm.
- On cut section:- oedematous, congested, trachea
and bronchial mucosa is pale, lumen contains
yellowish-green thick mucoid fluid same is present in
stomach.
- heart : 30 gm, right side chambers are full of blood
clots, congested.

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3. Abdominal cavity:
- Peritoneum intact.
- Mesentery intact and congested.
- Esophagus intact and congested
- Stomach intact contains bilious fluid, 5 ml in
volume, mucosa is pale.
- Liver – 195 gm, congested.
- Spleen – 30 gm, congested.
- Right kidney – 20 gm, left kidney – 25 gm, both are
congested.

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• Small intestine empty, large intestine contains
faecal material, mucosa was pale.
• Urinary bladder intact and empty.
• Internal and external genitalia intact.

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 OPINION

Cause of death : meningoencephalitis

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 discussion
• Unintentional injuries are the leading cause of death in children.
Infants and toddlers tolerate larger space–occupying traumatic
lesions compared with adults, but consequences are similar.[1]
• Bacterial meningitis is a complication to be considered in head
injury with basilar skull fracture, particularly when associated with
cerebrospinal fluid leakage, even though the injury occurred several
years earlier, and is usually a serious condition. S. pneumoniae was
the most common bacteria.[2]
• The offence of abandoning a living child under 12 years of age, is
triable under sec 317 IPC and is punishable with imprisonment up
to 7 years and if such abandoned child actually dies, then the
offender may be punishable for causing homicide, amounting or not
amounting to murder.[3]

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• Bruise in children change colour rapidly and may be completely
absorbed in a few days. The rate of colour change in quite variable,
not only between persons, but in the same person and from bruise
to bruise. They are at first bright red, then yellow before
disappearing. usually within 2 weeks they disappear. In case of
subarachnoid haemorrhage the blood mixes with CSF and may be
distributed over the whole of the brain and slightly yellow
discolouration of the leptomeninges is seen as the subarachnoid
haemorrhage becomes older[4]
• Recent blood effusion is bright red in colour, which becomes
chocolate colour or brown after some days, and pale brownish
yellow in 12 -25 days. As the time progresses, the coagulum
becomes firmer and laminated.[4]

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 references
• Ciurea A V , Gorgan M R, Tascu A, Sandu A M, Rizea R E;
Traumatic brain injury in infants and toddlers, 0–3 years old;
Journal of Medicine and Life; 2011 Aug 15; 4(3): 234–243.
• Sara Figueiredo Santos 1, Fernanda Rodrigues, Andrea Dias, José Augusto
Costa, Alexandre Correia, Guiomar Oliveira; Post-traumatic
meningitis in children: eleven years' analysis; Acta Medica
Portuguesa; May-Jun 2011;24(3):391-8. Epub 2011 Aug 12.
• Nandy A; infanticide; Principles of Forensic Medicine including Toxicology;
3rd edition 2010; p 683.
• Reddy K S N, Murty O P; Mechanical injuries; The Essentials
of Forensic Medicine & Toxicology; 34th edition 2017; p 177,
247.

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