Abstract
Cerebrovascular alterations are frequent in bacterial meningitis and found in roughly 50% of these patients. In viral meningitis, they are rare. When present, arterial alterations are associated with a more severe clinical cause, a poorer outcome, and with the occurrence of strokes. The characteristic finding of arterial narrowing consists of a blood velocity increase from day 1 to day 6 and can persist until day 21. In some cases, the latter are present for several weeks or months and may at this time point represent a definitive stenotic arteriopathy. Causative pathogens more frequently associated with arterial narrowing are Streptococcus pneumoniae, Neisseria meningitidis, Mycobacterium tuberculosis, Cryptococcus, Treponema pallidum and Borrelia burgdorferi, Varicella zoster virus, Herpes simplex virus, and HIV(irus), and Cysticercosis due to Taenia solium. Although recommended, it is unclear whether adjunctive steroid therapy is helpful to prevent negative effects of vascular alterations.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhäupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology. 1992;42:1497–504.
Haring HP, Rötzer HK, Reindl H, Berek K, Kampfl A, Pfausler B, et al. Time course of cerebral blood flow velocity in central nervous system infections. A transcranial Doppler sonography study. Arch Neurol. 1993;50:98–101.
Müller M, Merkelbach S, Hasert K, Schimrigk K. Transkranielles Doppler-sonographisches Monito-ring von Patienten mit viralen Infektionen des zentralen Nervensystems. Nervenarzt. 1995;66:754–9.
Müller M, Merkelbach S, Huss GP, Schimrigk K. Clinical relevance and frequency of transient stenoses of the middle and anterior cerebral arteries in bacterial meningitis. Stroke. 1995;26:1399–403.
Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister H-W. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care. 2011;15:R281.
Gans J, Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.
Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;9:CD004405.
Buchholz G, Koedel W, Pfister H-W, Kastenbauer S, Klein M. Dramatic reduction of mortality in pneumococcal meningitis. Crit Care. 2016;20:312.
Müller M, Merkelbach S, Hermes M, König J, Schimrigk K. Relationship between short-term outcome and occurrence of basal cerebral artery stenosis in survivors of bacterial meningitis. J Neurol. 1998;245:87–92.
Müller M, Merkelbach S, Hermes M, Schimrigk K. Transcranial Doppler sonography at the early stage of acute central nervous systems infections in adults. Ultrasound Med Biol. 1996;22:173–8.
Chang WN, Lu CH, Chang HW, Lui CC, Tsai NW, Huang CR, et al. Time course of cerebral hemodynamics in cryptococcal meningitis in HIV-negative adults. Eur J Neurol. 2007;14:770–6.
Lu CH, Chang WN, Chang HW, Chung KJ, Tsai NW, Lui CC, et al. Clinical relevance of intracranial arterial stenoses in tuberculous and cryptococcal meningitis. Infection. 2007;35:359–63.
Merkelbach S, Röhn S, König J, Müller M. Usefulness of clinical scores to predict outcome in bacterial meningitis. Infection. 1999;27:239–43.
Møller K, Qvist T, Tofteng F, Sahl C, Sønderkaer S, Dethloff T, et al. Cerebral blood flow and metabolism during infusion of norepinephrine and propofol in patients with bacterial meningitis. Stroke. 2004;35:1333–9.
Haring H, Kampfl A, Grubwieser G, Donnemiller E, Pfausler B, Schmutzhard E. Cerebral blood flow velocity and perfusion in purulent meningitis: a comparative TCD and 99M-TC-HMPAO-SPECT study. Eur J Neurol. 1998;5:75–81.
Merkelbach S, Müller M, Huber G, Schimrigk K. Alterations of cerebral blood flow in the acute phase of bacterial and viral meningoencephalitis. AJNR Am J Neuroradiol. 1998;19:433–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Algorithm
Algorithm
ABCD Airway-breathing-circulation-disability, PI Pulsatility index, GCS Glasgow coma scale, RASS Richmond agitation and sedation scale, ICP Intracranial pressure, CO Cardiac output, IV Intravenous, BCTS Brain computed tomography scan, CSF Cerebral spinal fluid, ABC Airway-breathing-circulation, CBFV Cerebral blood flow velocity
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Müller, M., Österreich, M., Lakatos, L., Bolognese, M. (2022). Central Nervous System Infection in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) to Cerebral Hemodynamics Monitoring. In: RodrÃguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_69
Download citation
DOI: https://doi.org/10.1007/978-3-030-81419-9_69
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-81418-2
Online ISBN: 978-3-030-81419-9
eBook Packages: MedicineMedicine (R0)