At 08:51 PM 8/15/99 -0400, G Hertz wrote: >Today's case: >I'm covering ER this weekend and at noon get called in to see a 3 month old >with a 4 day hx of fever (99.5-102 otic), no vomiting, one "sort of loose" >stool, and bulging fontanelle since 7pm previous evening. > >My question is this: The only kids I've seen before with a bulging ant. >fontanelle have been VERY ill [status or comatose] - have you seen this >level of presentation before? > >[I'll post labs, etc. in a later post] >Gail >Gail S. Hertz, MD, IBCLC > Once a previous associate saw a young infant who looked kind of like a unicorn (I don't mean to be funny - it gives you an idea of how far the fontanelle was sticking out) but wasn't horribly toxic. The child wound up having viral meningitis, and I was told at the time that bacterial meningitis causes less bulging (relatively speaking) than viral. I also agree with David that the child might just not *yet* be critically ill. One question though for David - why the ultrasound? Are you concerned about a mass lesion? The presentation is purely infectious, I'd say this child needs a tap ASAP, and if it is early bacterial meningitis I'd be concerned about the extra time taken for an ultrasound. Michael Sachs, M.D. General Pediatrician