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Cerebral hemodynamics in the posterior circulation of patients with bacterial meningitis
M Müller1, S Merkelbach, K Schimrigk
1Department of Neurology, Saarland University Hospital, Homburg/Saar.
Objectives:
Stenoses of the middle and anterior cerebral artery (MCA,ACA) are a clinical relevant complication of bacterial meningitis. We examined the involvement of the posterior cerebral (PCA) and of the basilar artery (BA) into the inflammatory process.
Material & Methods:
39 unselected patients (26 men, 13 women; mean +/- SD age, 49 +/- 17 years) with bacterial (n = 37) and fungal (n = 2) meningitis underwent serial transcranial Doppler sonography recordings of the mean blood velocity (MBV) and the pulsatility index (PI) in the MCA, ACA and PCA, in the BA and in the submandibular internal carotid artery on Days 1, 3, 5, 8, 14 and 21 after admission. The results of the PCA and of the BA were compared to normal reference values and correlated to corresponding neurological signs. The criterion to assume a stenosis was: for the BA an MBV > or = 95 cm/s, for the PCA an MBV > or = 85 cm/s.
Results:
Compared with the controls MBV in both arteries was normal on Days 1 and 8-21, but significantly increased on Days 3 and 5. The PI was significantly increased in the BA on all days and in the PCA on Days 1 and 8-21. Stenoses of the PCA (4 of 43) and of the BA (4 of 32) remained without corresponding neurological signs, and occurred only in patients with two or more narrowed arteries of the anterior circulation (p < 0.05).
Conclusion:
In bacterial meningitis, hemodynamic disturbances in the posterior circulation are less severe than in the anterior circulation and are clinically well tolerated.
Insights
Bacterial meningitis can cause arterial stenosis. While posterior circulation involvement (posterior cerebral and basilar arteries) occurs, it is less severe and clinically well-tolerated compared to anterior circulation issues.
Area of Science:
- Neurology
- Vascular Medicine
- Infectious Diseases
Background:
- Bacterial meningitis frequently leads to stenosis in the middle and anterior cerebral arteries.
- The involvement of the posterior cerebral artery (PCA) and basilar artery (BA) in this inflammatory process is less understood.
Purpose of the Study:
- To investigate the involvement of the posterior cerebral artery (PCA) and basilar artery (BA) in bacterial meningitis.
- To assess hemodynamic changes in the posterior circulation during meningitis.
Main Methods:
- Serial transcranial Doppler sonography was performed on 39 meningitis patients.
- Mean blood velocity (MBV) and pulsatility index (PI) were measured in cerebral arteries (MCA, ACA, PCA) and basilar artery (BA).
- PCA and BA results were compared to normal values and correlated with neurological signs.
Main Results:
- Mean blood velocity (MBV) in PCA and BA was transiently increased on Days 3 and 5.
- Pulsatility index (PI) was elevated in the BA throughout and in the PCA on Days 1 and 8-21.
- Stenoses in PCA and BA occurred in a minority of patients and were associated with anterior circulation narrowing, without distinct neurological signs.
Conclusions:
- Hemodynamic disturbances in the posterior circulation during bacterial meningitis are generally less severe than in the anterior circulation.
- These posterior circulation changes are typically well-tolerated clinically.