Cerebral haemodynamics in acute bacterial meningitis in adults
From the Departments of 1Neurology and 3Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, and 2Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
Address correspondence to Dr Wen-Neng Chang, Department of Neurology, Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. email: chlu99{at}ms44.url.com.tw
Received 18 March 2006 and in revised form 4 August 2006
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Abstract |
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Background: Vascular complications are an important cause of neurological sequelae among adult survivors of acute bacterial meningitis (ABM).
Aim: To examine the haemodynamic changes associated with ABM.
Methods: Serial transcranial colour-coded sonography (TCCS) and magnetic resonance angiography (MRA) were used to examine cerebrovascular changes in adult ABM patients. Outcome at 3 months was categorized using a modified Barthel index.
Results: We recruited 24 patients, 12 men and 12 women, aged 21–68 years. Mean cerebral blood flow velocity (Vmean) increased from day 1 to day 4 in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA). On day 4, Vmean values in the MCA, ACA and PCA were all significantly higher than reference values in healthy volunteers. At 3 months follow-up, 16 cases had good outcomes, while the other eight had poor outcomes. Under multiple logistic regression analysis, only Glasgow coma score (GCS) at admission was independently associated with the three-month outcome.
Discussion: In these patient, stenosis as demonstrated by TCCS did not wholly coincide with stenosis as demonstrated by MRA, and the presence of intracranial stenosis was not predictive of a poor outcome at 3 months. Further studies are needed to delineate the characteristics and significance of cerebrovascular changes in adult ABM.