Time Course of Cerebral Blood Flow Velocity in Central Nervous System Infections

Haring, Hans‐Peter; Rötzer, Hans-Klaus; Reindl, Hermine; Berek, Klaus; Kampfl, A.; Pfausler, Bettina; Schmutzhard, Erich

doi:10.1001/archneur.1993.00540010092024

Cited by 64 publications

(41 citation statements)

References 18 publications

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“…Haring and his colleagues studied 110 patients with various infections of the CNS; 37% of patients had bacterial infection, 24% had viral processes, and 39% had unclassified disease [70]. TCD sonography documented an increase of blood-flow velocity in the middle cerebral artery in 77% of patients infected with pneumococci and in 65% of those with meningococcal meningitis.…”

Section: Cerebral Blood Flow and Metabolism During Bacterial Meningitismentioning

confidence: 99%

Mechanisms of Brain Injury in Bacterial Meningitis: Workshop Summary

Pfister

Fontana²,

Täuber³

et al. 1994

Clinical Infectious Diseases

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Morbidity and mortality associated with bacterial meningitis remain high, although antibiotic therapy has improved during recent decades. The major intracranial complications of bacterial meningitis are cerebrovascular arterial and venous involvement, brain edema, and hydrocephalus with a subsequent increase of intracranial pressure. Experiments in animal models and cell culture systems have focused on the pathogenesis and pathophysiology of bacterial meningitis in an attempt to identify the bacterial and/or host factors responsible for brain injury during the course of infection. An international workshop entitled "Bacterial Meningitis: Mechanisms of Brain Injury" was organized by the Department of Neurology at the University of Munich and was held in Eibsee, Germany, in June 1993. This conference provided a forum for the exchange of current information on bacterial meningitis, including data on the clinical spectrum of complications, the associated morphological alterations, the role of soluble inflammatory mediators (in particular cytokines) and of leukocyte-endothelial cell interactions in tissue injury, and the molecular mechanisms of neuronal injury, with potential mediators such as reactive oxygen species, reactive nitrogen species, and excitatory amino acids. It is hoped that a better understanding of the pathophysiological events that take place during bacterial meningitis will lead to the development of new therapeutic regimens.Although the recent licensure of Haeniophilus influenzae type b (Hib) polysaccharide conjugate protein vaccines has had a marked impact on the incidence of invasive Hib disease in the United States and Western Europe. bacterial meningitis overall remains a significant problem worldwide. In addition, despite the introduction of new antimicrobial agents and improved diagnostic techniques, the mortality and morbidity associated with bacterial meningitis remain unacceptably high. This discrepancy between a rapid bacteriologic response at the site of infection (i.e .. eradication of viable bacteria from the CSF due to treatment with potent bactericidal agents) and the persistence of the associated neurological sequelae and mortality has prompted intense investigation over the past two decades into the pathophysiology of this disease. Indeed. recent clinical studies have employed adjunctive agents (e.g .. dexamethasone) in an attempt to reduce mortality and alleviate neurological sequelae [1][2][3][4]. These studies and the resulting recommendations regarding the use of adjunctive dexamethasone have recently been reviewed [5.6].In line with the current emphasis on the pathogenesis and pathophysiology of bacterial meningitis. two workshops were held in California in the 1980s [7]. Recognizing that many advances have been made in this field in the several years since those meetings. the Department of Neurology at the University of Munich organized a similar workshop, which was held in Eibsce. Germanv. on 25 and 26 June 1993. As IS evident from its title-"Bacterial Meningitis: Mechanisms...

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Section: Cerebral Blood Flow and Metabolism During Bacterial Meningitismentioning

confidence: 99%

Mechanisms of Brain Injury in Bacterial Meningitis: Workshop Summary

Pfister

Fontana²,

Täuber³

et al. 1994

Clinical Infectious Diseases

View full text Add to dashboard Cite

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“…According to literature review, the impaired CBF chemoregulation is almost exclusively confined to bacterial meningitis [9]. That is probably because of particular interest in pneumococcal meningitis patophysiology and the great number of experimental studies [20][21][22][23][24]. The lipid peroxidation and effects of matrix metalloproteinases with consequent endothelial dysfunction seems a plausible explanation.…”

Section: Discussionmentioning

confidence: 99%

Prospective observational cohort study of cerebrovascular CO2 reactivity in patients with inflammatory CNS diseases

Lepur

Kutleša

Baršić

2011

Eur J Clin Microbiol Infect Dis

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Word count of the text: 3089Word count of the abstract: 258 Conflict of interest: noneThere was no financial support for this study. 2 ABSTRACT PURPOSEThe purpose of this study was to evaluate the significance of cerebrovascular CO 2 reactivity (CO 2 R) in the course and outcome of inflammatory CNS diseases. METHODSSixty eight patients with inflammatory CNS diseases and thirty healthy volunteers were included in this prospective observational cohort study. The observational period was between January 2005 and May 2009. CO 2 reactivity was measured by Transcranial Doppler ultrasound (TCD) using the breath-holding method. We compared patients with normal CO 2 R (BHI m ≥ 1.18 = BHI N group) with patients who showed impaired CO 2 R (BHI m < 1.18 = BHI R group). We also analyzed the association of impaired CO 2 R with the etiology, severity and outcome of disease. RESULTSWhen compared to BHI N group, the patients from BHI R group were older, had a heavier consciousness disturbance, experienced more frequent respiratory failure, and subsequently had worse outcomes. There were no fatalities among the 28 patients in the BHI N group. The comparison of subjects with bacterial and non-bacterial meningitis revealed no significant differences. The unfavorable outcome of disease (GOS 1-3) was significantly more common in subjects with impaired CO 2 reactivity (62.5% vs. 10.7%).Logistic regression analysis was performed in order to establish the prognostic value of BHI m . The outcome variable was unfavorable outcome (GOS 1-3), while the independent variables were age, GCS and BHI m . The age and BHI m showed the strongest influence on disease outcome. A decrease of BHI m for each 0,1 unit increased the risk of unfavorable outcome for 17%. CONCLUSIONSOur study emphasizes the importance of CO 2 reactivity assessment in patients with inflammatory CNS diseases.

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“…Consequently, serial follow-up studies are required to assess the presence and outcome of cerebral vasculitis. Recently, several studies have shown that TCD may be useful in the evaluation of cerebral circulation in certain inflammatory conditions of the central nervous system [15, 16, 17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Cerebral Cysticercotic Arteritis: Detection and Follow-Up by Transcranial Doppler

et al. 1998

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Intracranial arteritis is a well-known complication of cerebral cysticercosis. The aim of this study was to explore the possible role of transcranial Doppler (TCD) in the evaluation of cysticercotic arteritis in 9 patients with subarachnoid cysticercosis and stroke. Arteritis of main basal vessels was detected by TCD in 7 of 10 arterial lesions that were demonstrated by cerebral angiography. The Doppler pattern was occlusive in 2 cases and stenotic in 5. In the 3 patients with lacunar infarcts, both cerebral angiography and TCD were normal. In 6 arterial lesions followed serially with TCD a stenotic pattern resolved within 4 and 6 months in 3 cases and remained in the stenotic range at 12 months in 1 case, whereas an occlusive pattern persisted at 6 and 18 months in the other 2 cases. In conclusion, TCD may be useful to detect and follow up cerebral vasculitis due to chronic cysticercotic arachnoiditis.

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Time Course of Cerebral Blood Flow Velocity in Central Nervous System Infections

Cited by 64 publications

References 18 publications

Mechanisms of Brain Injury in Bacterial Meningitis: Workshop Summary

Mechanisms of Brain Injury in Bacterial Meningitis: Workshop Summary

Prospective observational cohort study of cerebrovascular CO2 reactivity in patients with inflammatory CNS diseases

Cerebral Cysticercotic Arteritis: Detection and Follow-Up by Transcranial Doppler

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