Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis

Abstract

IntroductionIntracranial vascular complications are an important complication of acute bacterial meningitis. Ischemic stroke in meningitis is reported as a result of vasculitis, vasospasm, endocarditis or intraarterial thrombosis. The aim of the study was to identify the value of measuring cerebral blood flow velocity (CBFv) on transracranial doppler (TCD) in the identification of patients at risk for meningitis-associated stroke.MethodsWe retrospectively studied patients with acute bacterial meningitis who were treated in our university hospital from 2000 to 2009. Data were analyzed with the main focus on the incidence of an increase of CBFv on TCD, defined as peak systolic values above 150 cm/s, and the development of stroke.ResultsIn total, 114 patients with acute bacterial meningitis were treated, 94 of them received routine TCD studies during their hospital stay. 41/94 patients had elevated CBFv values. This increase was associated with an increased risk of stroke (odds ratio (95% confidence intervall) = 9.15 (1.96-42.67); p < 0.001) and unfavorable outcome (Glasgow Outcome Score < 4; odds ratio (95% confidence intervall) = 2.93 (1.23-6.98); p = 0.018). 11/32 (34.4%) patients with an increase of CBFv who received nimodipine and 2/9 (22.2%) patients with an increase of CBFv who did not receive nimodipine developed stroke (p = 0.69).ConclusionsIn summary, TCD was found to be a valuable bedside test to detect arterial alterations in patients with bacterial meningitis. These patients have an increased risk of stroke.

Treatment of vasospasm in bacterial meningitis with hemodynamic augmentation

“…Cerebrovascular complications due to arterial narrowing as evidenced by increased cerebral blood flow velocity (CBFv) greater than 150 cm/s on TCD is associated with an increased risk of stroke and poor functional outcomes [2]. We are unaware of any randomized, controlled trials evaluating treatment strategies for vasospasm in acute bacterial meningitis secondary to otomastoiditis.…”

“…Arterial narrowing is the most common finding, resulting most likely from inflammation associated with meningitis [2]. Currently, there is a paucity of data on the treatment of severe vasospasm associated with meningitis.…”

Syndrome de la queue de cheval après une méningite à Neisseria meningitidis de type C

“…La survenue d'AIC est plus classique puisque 8,8 % des méningites bactériennes sont compliquées d'ischémie céré-brale. Les mécanismes en cause sont la vascularite [4], le vasospasme, l'endocardite et les emboles septiques [5,6]. Les mécanismes avancés dans la survenue de péricardite après infection à Neisseria meningitidis sont une atteinte infectieuse avec péricardite purulente précoce ou une atteinte réactionnelle avec péricardite secondaire plus tardive [7].…”

Year in review 2011: Critical Care - neurocritical care

“…Different mechanisms underlie the development of stroke, the most common being arterial narrowing caused by an inflammatory vasculitis. Klein and colleagues [46] reviewed medical records of 94 patients with bacterial meningitis cared for at one institution looking for the incidence of arterial narrowing. Patients underwent TCD of commonly insonated cerebral vessels.…”