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Highly Infectious Diseases in Critical Care pp 175–194Cite as

Intracranial Pressure Monitoring and Management in Bacterial Meningitis

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Abstract

A controversial issue in bacterial meningitis’ management is intracranial pressure (ICP) monitoring usefulness to manage raised ICP or diminished cerebral perfusion pressure (CPP).

There are some pathophysiological events that give support to ICP monitoring in consciousness impairment bacterial meningitis patients.

One of them is the neurovascular unit’s damage reflected by permeability alteration, thrombosis, and ischemia secondary to vasculitis, direct neuronal injury with damage cascade’s initiation generating NMDA and free radicals, and anoikis.

The other is Dr. Rosner’s vasodilation (Vd)/vasoconstriction (Vc) cascade theory to explain autoregulation patency and cerebral blood flow (CBF) ensuring.

Based on TBI lessons and in poor outcome risk scores in bacterial meningitis, possible candidates for intracranial pressure monitoring could be selected on the following bases:

  1. (a)

    Age > 50 years old

  2. (b)

    Glasgow Coma Scale <9, consider <10 points with more than two risk factors

  3. (c)

    Space-occupying lesions (subdural empyema, brain abscess, hemorrhage)

  4. (d)

    Compress or absent basal cisterns in CT scan

  5. (e)

    CSF leucocyte count <1000 cell/mm3

  6. (f)

    Gram + germs in CSF Gram’s stain

  7. (g)

    Ultrasound signs of raised ICP

ICP and CPP estimation could be performed with different ultrasounds studies: transcranial Doppler, transcranial color code duplex, and optic nerve sheath diameter.

Invasive ICP monitoring technology is revised, as well as general and specific treatment of raised ICP.

Finally, there is an algorithm that summaries different treatment options that should bear in mind of neurocritical and general intensivists.

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Authors and Affiliations

  1. Hospital General de Agudos J. A. Fernández, Buenos Aires, Argentina

    Ignacio J. Previgliano

  2. Universidad Maimonides, Buenos Aires, Argentina

    Ignacio J. Previgliano

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  1. Ignacio J. Previgliano
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Editors and Affiliations

  1. Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize

    Jorge Hidalgo

  2. National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA

    Laila Woc-Colburn

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Previgliano, I.J. (2020). Intracranial Pressure Monitoring and Management in Bacterial Meningitis. In: Hidalgo, J., Woc-Colburn, L. (eds) Highly Infectious Diseases in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-33803-9_10

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  • DOI: https://doi.org/10.1007/978-3-030-33803-9_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-33802-2

  • Online ISBN: 978-3-030-33803-9

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