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Cerebrovascular involvement in the acute phase of bacterial meningitis
S Ries1, U Schminke, K Fassbender
1Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany.
Abstract:
Cerebral ischaemia is a common complication of bacterial meningitis. Although cerebrovascular involvement in the acute phase of inflammation may be particularly important for the still unacceptably high morbidity and mortality, only, a few studies have investigated cerebrovascular changes in bacterial meningitis. We prospectively investigated changes of intracranial cerebral blood flow velocities (CBFV) in 22 patients (12 men, 10 women, mean age 48 years, 19 years, SD) with bacterial meningitis, by means of transcranial Doppler sonography (TCD). According to previously published criteria the degree of arterial narrowing was assessed and related to the patients' outcome. Elevated CBFVs in the middle cerebral artery were documented in 18/22 patients with markedly increased systolic peak velocities (CBFV of > 210 cm/s) in 7 patients. Serial examinations performed in 11 patients showed elevated CBFV as early as day 1, reaching peak CBFV between day 3 and day 6 after onset of symptoms in most cases. Furthermore, cerebrovascular involvement was also documented by disturbances of physiological slow spontaneous oscillations of blood flow velocities in 5/10 patients examined with TCD. Low Glasgow Coma Scales (< 7) on admission (29% vs 0%), focal cerebral ischaemic deficits (29% vs 7%) and, seizures (43% vs 7%) were more frequent in patients with CBFV of > 210 cm/s. Finally, a poor clinical outcome was significantly related to severe vascular involvement (P < 0.05). In conclusion, cerebrovascular complications are frequently found in patients with bacterial meningitis. TCD is an easily applicable technique for revealing vascular changes non-invasively, even in severely ill patients. Since our data suggest an unfavourable course of the disease in association with increased CBFV in intracranial arteries, probably indicating vasospasm, TCD could potentially be used to identify high-risk patients who could benefit from adjuvant therapeutic interventions.
Insights
Bacterial meningitis frequently causes cerebral ischaemia. Transcranial Doppler (TCD) detects elevated cerebral blood flow velocities, indicating vascular changes and predicting poor outcomes in meningitis patients.
Area of Science:
- Neurology
- Vascular Medicine
- Infectious Diseases
Background:
- Cerebral ischaemia is a significant complication of bacterial meningitis, contributing to high morbidity and mortality.
- Cerebrovascular changes during acute meningitis inflammation are crucial but understudied.
- Few studies have prospectively investigated cerebrovascular alterations in bacterial meningitis.
Purpose of the Study:
- To prospectively evaluate intracranial cerebral blood flow velocities (CBFV) in bacterial meningitis patients.
- To assess the correlation between cerebrovascular changes and patient outcomes.
- To determine the utility of transcranial Doppler sonography (TCD) in identifying high-risk patients.
Main Methods:
- Prospective study involving 22 bacterial meningitis patients.
- Utilized transcranial Doppler sonography (TCD) to measure CBFV.
- Assessed arterial narrowing and disturbances in blood flow oscillations.
Main Results:
- Elevated CBFV in the middle cerebral artery was observed in 18/22 patients.
- Markedly increased systolic peak velocities (> 210 cm/s) occurred in 7 patients.
- Serial TCD showed elevated CBFV early (day 1), peaking between days 3-6; 5/10 patients had flow oscillation disturbances.
- Severe vascular involvement correlated with lower Glasgow Coma Scales, focal deficits, seizures, and poor clinical outcomes (P < 0.05).
Conclusions:
- Cerebrovascular complications are common in bacterial meningitis.
- TCD is a non-invasive tool for detecting vascular changes, even in critically ill patients.
- Increased CBFV, likely indicating vasospasm, is associated with an unfavorable prognosis, suggesting TCD's role in identifying patients for potential adjuvant therapies.