Role of Transcranial Doppler in the Evaluation of Vasculopathy in Tuberculous Meningitis

Abstract

BackgroundVascular complications are important causes of cerebral infarction in tuberculous meningitis (TBM).Transcranial Doppler ultrasonography (TCD) is a non-invasive tool that can provide real-time information about cerebral hemodynamics. However, the literature on the role of TCD in the diagnosis or monitoring of vasculopathy associated with TBM is scarce. We explored the role of TCD in the diagnosis and monitoring of TBM-related vasculopathy of the major intracranial arteries.MethodsConsecutive patients with TBM admitted to our tertiary center between 2011 and 2015 were included. All patients underwent TCD evaluation within 2 weeks of hospitalisation and it was repeated 2 weeks later. Mean flow velocity (Vmean) and pulsatility index (PI) were recorded. Flow velocities obtained from the submandibular internal carotid artery were also measured to calculate the Lindegaard ratio. A correlation was made between the patients who demonstrated vasculopathy on TCD, and patients with confirmed focal narrowing on computed tomography angiography (CTA) or magnetic resonance angiography (MRA). The modified Rankin scale (mRS) was used to assess the clinical outcome at three and six months.ResultsA total of 36 patients were recruited. Focally elevated flow velocities in the middle cerebral artery (MCA) were observed in 11 (30.6%) patients, bilaterally in 6 of them. The Lindegaard ratio was elevated (>3) in 10 (90.9%) of them, which occurred as early as the fourth day of hospitalization and persisted as long as four months. Eighty percent of patients with TBM vasculopathy by TCD criteria, also had narrowing on CTA or MRA. Ten patients (27.8%) achieved good outcome (mRS 0–2) at 3 months, which increased to 13 (36.1%) at 6 months.ConclusionA considerable proportion of patients with TBM develops intracranial vasculopathy, which can be reliably diagnosed and monitored using TCD.

Transcranial Doppler as a Bedside Evaluation Tool in Tubercular Meningitis: Case Report and Review of Literature

“…80% of patients having TCD criteria for vasculopathy, showed focal narrowing of major intracranial arteries on either CTA/MRA. 6 Van-Toorn et. al.…”

“…In our patient, initial TCD assessment at the time of presentation showed high peak systolic and mean flow velocities in the insonated intracranial vessels, which correlated with dense basal exudates and pachymeningeal enhancement on MR imaging. Based on the criteria proposed by various authors, 6,[9][10][11] TCD values indicated Left PCA vasculopathy (MFV> 85 cm/sec) with>50% stenosis (PSV >145 cm/sec) and <50% narrowing in right PCA (PSV 100-145 cm/sec). After treatment with steroids, the basal exudates settled as shown in repeat MRI, and TCD showed reduced peak and mean flow velocities, signifying reduced obstruction to blood flow in the tested intracranial vessels.…”

Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases

“…TCD examination is a classic means of diagnosing cerebral blood vessels. TCD is a non-invasive method developed in the early 1980s that examines intracranial hemodynamics ( 26 ). In 1982, Aaslid et al utilized this non-invasive technique for the first time to detect low-speed blood flow in basal cerebral arteries ( 27 ).…”

<b><i>Streptococcus pneumoniae</i></b> Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics

“…Many possible etiologies have been identified including vasculitis, vasospasm, endocarditis or intra-arterial thrombosis [3]. Transcranial Doppler (TCD) ultrasonography is a non-invasive approach to detect intracranial vasculopathy and can identify patients at risk of stroke from the underlying infection [4,5]. We present a case report of Streptococcus pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial TCD improvement.…”