Three Phases of Cerebral Arteriopathy in Meningitis: Vasospasm and Vasodilatation Followed by Organic Stenosis

Abstract

A systematic radiological and pathological study of the cerebral arteries was made in an autopsy case of meningitis associated with three phases of cerebral arteriopathy. The latter consisted of vasospasm, vasodilatation, and organic stenosis. A marked change in the caliber of the cerebral arteries was demonstrated 3 times. Vasospasm, the stimulus phenomenon, was produced by the surrounding purulent material. Vasodilatation, the paralytic phenomenon, was presumably due to decreased contractile energy in association with myonecrosis. Organic stenosis, the repair process, was due to the organization of subendothelial edema with resultant intimal thickening. Evidence of increased endothelial permeability, subendothelial proliferation of smooth muscle cells, and necrosis of the latter in the media is presented in both light and electron micrographs.

Relationship between short-term outcome and occurrence of cerebral artery stenosis in survivors of bacterial meningitis

“…Therefore, we have focused on the diagnostic and therapeutic management of the complications of the inflammatory process [34]. Among the complications, the inflammatory changes of the large and small intracranial vessels seem to be an important outcome prediction factor as indicated by pathological and angiographic findings [16,29,34,39]. The use of MBV measurements to indicate arterial narrowing of the large basal cerebral arteries in bacterial meningitis is complicated by other factors increasing MBV: first, inflammatory hyperaemia [25,28,35,38]; and second, the decrease of an increased intracranial pressure [22].…”

“…The complications of the inflammation, such as alterations of the cerebral blood flow due to raised intracranial pressure, brain oedema or hydrocephalus, as well as focal and generalized seizures, abscess, stroke or dural sinus thrombosis [3,4,22,29,34] are responsible for the occurrence of focal neurological deficits and for the poor prognosis. The occurrence of stroke in bacterial meningitis has been angiographically found to be accompanied by occlusions or severe stenosis of the intracranial internal carotid artery (ICA) and of the middle and anterior cerebral arteries (MCA and ACA) [6,9,16,17,20,29,39]. The histological inflammatory changes demonstrated for the MCA and ACA can also be found in the basilar artery (BA) [39].…”

“…The occurrence of stroke in bacterial meningitis has been angiographically found to be accompanied by occlusions or severe stenosis of the intracranial internal carotid artery (ICA) and of the middle and anterior cerebral arteries (MCA and ACA) [6,9,16,17,20,29,39]. The histological inflammatory changes demonstrated for the MCA and ACA can also be found in the basilar artery (BA) [39]. However, the involvement of the BA or its branches, including the posterior cerebral artery (PCA), in the meningitic disorder seems to be rarely found by clinical, computed tomographic, angiographic and transcranial Doppler ultrasound (TCD) examination [15,19,24,26,27,29,40].…”

“…The angiographically demonstrated stenosis of the main cerebral arteries in bacterial meningitis usually affects one or more whole segments [6,9,16,17,20,29,39], a finding comparable to the more diffuse process of vasospasm in subarachnoid haemorrhage. In the latter condition, vasospasm can be accompanied by delayed ischaemic neurological deficits, which can adversely affect clinical outcome.…”

Central nervous system infections: A critical care approach

“…Another complication of CNS infection is cerebral infarction, which can result from vasospasm [71]. Vasospasm has been reported in tuberculous and purulent meningitis [72]. Bacterial meningitis can also cause vasculitis, which appears as segmental increases in blood flow velocity in the basal cerebral arteries on transcranial Doppler studies.…”