Monitoring of Intracranial Pressure in Meningitis
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Published on: March 26, 2019
Bart Depreitere1, Dominike Bruyninckx2, Fabian Güiza3
1Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium. bart.depreitere@uzleuven.be.
Background:
The literature on intracranial pressure (ICP) monitoring in meningitis is limited to case reports and a handful of descriptive series. The aim of this study is to investigate relationships among ICP, cerebral perfusion pressure (CPP), and outcome in meningitis and to identify whether ICP affected clinical decisions.
Methods:
Between 1999 and 2011, a total of 17 patients with meningitis underwent ICP monitoring at the University Hospitals Leuven. Charts were reviewed for clinical history, ICP/CPP data, imaging findings, and Glasgow Outcome Scale score. Univariate correlations were computed for outcome and ICP/CPP variables, computed tomography characteristics, and Corticosteroid Randomization After Significant Head Injury outcome model variables. Treatment decisions were assessed regarding whether or not they were based on ICP.
Results:
At drain placement, Glasgow Coma Scale scores showed a median of 8 (range 3-12). Six of 17 patients had either one or two nonreactive pupils. Significant correlations with outcome were found for the highest documented ICP value (r = -0.70), the number of episodes when CPP <50 mmHg (r =-0.50), the lowest documented CPP value (r = 0.61), and pupil reactivity (r = 0.57). Treatment was influenced by ICP in all patients.
Conclusion:
The results support the notion that in meningitis high ICP and low CPP represent secondary insults. The poor condition of the patients illustrates that the level of suspicion for increased ICP in meningitis may not be high enough.
Insights
Intracranial pressure (ICP) monitoring in meningitis is crucial. High ICP and low cerebral perfusion pressure (CPP) correlate with poor outcomes, indicating secondary insults that require clinical attention.
Area of Science:
- Neurology
- Critical Care Medicine
- Infectious Diseases
Background:
- Limited literature exists on intracranial pressure (ICP) monitoring in meningitis.
- Existing studies primarily consist of case reports and descriptive series.
- This study aims to address this gap by investigating ICP and cerebral perfusion pressure (CPP) in meningitis patients.
Purpose of the Study:
- To investigate the relationships among ICP, CPP, and patient outcomes in meningitis.
- To determine if ICP monitoring influences clinical decision-making in meningitis management.
Main Methods:
- Retrospective review of 17 meningitis patients who underwent ICP monitoring between 1999 and 2011.
- Analysis of clinical history, ICP/CPP data, imaging findings, and Glasgow Outcome Scale scores.
- Univariate correlations were computed for outcome variables, ICP/CPP, and imaging characteristics.
Main Results:
- Significant correlations were found between outcome and highest ICP (r = -0.70), episodes of CPP <50 mmHg (r = -0.50), lowest CPP (r = 0.61), and pupil reactivity (r = 0.57).
- ICP monitoring directly influenced treatment decisions in all studied patients.
- Patients presented with low Glasgow Coma Scale scores and nonreactive pupils at drain placement.
Conclusions:
- Elevated ICP and low CPP in meningitis signify secondary insults.
- The findings suggest that the clinical suspicion for increased ICP in meningitis may be insufficient.
- ICP monitoring is vital for guiding treatment and improving outcomes in severe meningitis.
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