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The value of transcranial Doppler imaging in children with tuberculous meningitis
Ronald van Toorn1, H Simon Schaaf, Regan Solomons
1Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, PO Box 19063, Tygerberg, Cape Town, 7505, Western Cape, South Africa, vtoorn@sun.ac.za.
Insights
Transcranial Doppler imaging (TCDI) is not a reliable indicator of intracranial pressure (ICP) in children with tuberculous meningitis (TBM). However, TCDI can detect basal artery stenosis due to vasculitis, a common finding in TBM.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Infectious Diseases
Background:
- Tuberculous meningitis (TBM) is a severe infection in children.
- TBM often leads to complications like raised intracranial pressure (ICP) and cerebral vasculopathies.
- Transcranial Doppler imaging (TCDI) is a non-invasive tool to assess cerebral hemodynamics.
Purpose of the Study:
- To investigate cerebrovascular hemodynamics in children with TBM using serial TCDI.
- To explore the relationship between pulsatility index (PI) and ICP in TBM patients.
- To identify specific TCDI findings indicative of TBM complications.
Main Methods:
- Serial TCDI was performed on 20 children diagnosed with TBM.
- Cerebrovascular hemodynamics, including pulsatility index (PI), were analyzed.
- Correlation between PI and ICP was assessed, along with blood flow velocities (BFV) and middle cerebral artery (MCA) parameters.
Main Results:
- A poor correlation was found between ICP and PI in communicating hydrocephalus.
- High BFV in basal cerebral arteries persisted for 7 days, suggesting vasculitis-induced stenosis.
- Complete MCA occlusion and low MCA velocities/PI correlated with cerebral infarcts.
Conclusions:
- TCDI-derived PI is unreliable for indicating raised ICP in pediatric TBM with hydrocephalus.
- Vasculitis-induced basal artery stenosis is a common finding in acute TBM.
- TCDI remains valuable for detecting cerebrovascular changes in TBM.
Purpose:
Transcranial Doppler imaging (TCDI) is potentially a valuable investigational tool in children with tuberculous meningitis (TBM), a condition often complicated by pathology relevant to Doppler imaging such as raised intracranial pressure (ICP) and cerebral vasculopathies.
Methods:
Serial TCDI was performed on 20 TBM children with the aim of investigating cerebrovascular haemodynamics and the relationship between pulsatility index (PI) and ICP.
Results:
We observed a poor correlation between ICP and PI in children with communicating hydrocephalus (p = 0.72). No decline in PI was noted following 7 days of medical therapy for communicating hydrocephalus (p = 0.78) despite a concomitant decline in ICP. Conversely, a decline in PI was noted in all four children with non-communicating hydrocephalus who underwent cerebrospinal fluid diversion. High blood flow velocities (BFV) in all the basal cerebral arteries were observed in 14 children (70 %). The high BFV persisted for 7 days suggesting stenosis due to vasculitis rather than functional vasospasm. Complete middle cerebral artery (MCA) occlusion, subnormal mean MCA velocities (<40 cm/s) and PIs (<0.4) correlated with radiologically proven large cerebral infarcts.
Conclusions:
TCDI-derived PI is not a reliable indicator of raised ICP in children with tuberculous hydrocephalus. This may be attributed to individual variation of tuberculous vascular disease, possibly compromising cerebral vascular compliance and resistance. Basal artery stenosis secondary to vasculitis is observed during the acute stage of TBM in the majority of children.
