Abstract
Background: The literature on intracranial pressure (ICP) monitoring in meningitis is limited to case reports and a handful of descriptive series. The aim of this study is to investigate relationships among ICP, cerebral perfusion pressure (CPP), and outcome in meningitis and to identify whether ICP affected clinical decisions. Methods: Between 1999 and 2011, a total of 17 patients with meningitis underwent ICP monitoring at the University Hospitals Leuven. Charts were reviewed for clinical history, ICP/CPP data, imaging findings, and Glasgow Outcome Scale score. Univariate correlations were computed for outcome and ICP/CPP variables, computed tomography characteristics, and Corticosteroid Randomization After Significant Head Injury outcome model variables. Treatment decisions were assessed regarding whether or not they were based on ICP. Results: At drain placement, Glasgow Coma Scale scores showed a median of 8 (range 3–12). Six of 17 patients had either one or two nonreactive pupils. Significant correlations with outcome were found for the highest documented ICP value (r = −0.70), the number of episodes when CPP <50 mmHg (r =−0.50), the lowest documented CPP value (r = 0.61), and pupil reactivity (r = 0.57). Treatment was influenced by ICP in all patients. Conclusion: The results support the notion that in meningitis high ICP and low CPP represent secondary insults. The poor condition of the patients illustrates that the level of suspicion for increased ICP in meningitis may not be high enough.
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References
Kasanmoentalib ES, Brouwer MC, van de Beek D (2013) Update on bacterial meningitis: epidemiology, trials and genetic association studies. Curr Opin Neurol 26:282–288
Nudelman Y, Tunkel AR (2009) Bacterial meningitis: epidemiology, pathogenesis and management update. Drugs 69:2577–2596
Noah N (2002) Surveillance of bacterial meningitis in Europe 1999/2000. Euro Surveill 6:2116
Merkelbach S, Röhn S, König J, Müller M (1999) Usefulness of clinical scores to predict outcome in bacterial meningitis. Infection 27:239–243
Schutte CM, van der Meyden CH (1998) A prospective study of Glasgow Coma Scale (GCS), age, CSF-neutrophil count, and CSF-protein and glucose levels as prognostic indicators in 100 adult patients with meningitis. J Infect 37:112–115
Bordes J, Boret H, Lacroix G, Prunet B, Meaudre E, Kaiser E (2011) Decompressive craniectomy guided by cerebral microdialysis and brain tissue oxygenation in a patient with meningitis. Acta Anaesthesiol Scand 55:130–133
Lindvall P, Ahlm C, Ericsson M, Gothefors L, Naredi S, Koskinen LO (2004) Reducing intracranial pressure may increase survival among patients with bacterial meningitis. Clin Infect Dis 38:384–390
Sala F, Abbruzzese C, Galli D, Grimaldi M, Abate MG, Sganzerla EP, Citerio G (2009) Intracranial pressure monitoring in pediatric bacterial meningitis: a fancy or useful tool? A case report. Minerva Anestesiol 75:746–749
Trendelenburg G, Jussen D, Grimmer S, Jakob W, Hiemann NE, Horn P (2011) Invasive pressure monitoring saves from tuberculous meningitis with fulminant generalized brain edema. Front Neurol 2:69
de Vedia L, Arechavala A, Calderón MI, Maiolo E, Rodríguez A, Lista N, Di Virgilio E, Cisneros JC, Prieto R (2013) Relevance of intracranial hypertension control in the management of Cryptococcus neoformans meningitis related to AIDS. Infection 41:1073–1077
Bullock MR, Povlishock JT (2007) Guidelines for the management of severe traumatic brain injury – 3rd edition. J Neurotrauma 24(Suppl 1):S1–S106
Odetola FO, Clark SJ, Lamarand KE, Davis MM, Garton HJ (2011) Intracranial pressure monitoring in childhood meningitis with coma: a national survey of neurosurgeons in the United States. Pediatr Crit Care Med 12:350–356
Shetty R, Singhi S, Singhi P, Jayashree M (2008) Cerebral perfusion pressure – targeted approach in children with central nervous system infections and raised intracranial pressure: is it feasible? J Child Neurol 23:192–198
Edberg M, Furebring M, Sjölin J, Enblad P (2011) Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand 55:732–739
MRC CRASH Trial Collaborators (2008) Predicting outcome after traumatic brain injury: practical prognostic models based on large a cohort of international patients. BMJ 336:425–429
Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T, Global Neurotrauma Research Group (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481
Aries MJ, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, Hutchinson PJ, Brady KM, Menon DK, Pickard JD, Smielewski P (2012) Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 40:2456–2463
Steiner LA, Czosnyka M, Piechnik K, Smielewski P, Chatfield D, Menon DK, Pickard JD (2002) Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 30:733–738
Møller K, Larsen FS, Qvist J, Wandall JH, Knudsen GM, Gjørup IE, Skinhøj P (2000) Dependency of cerebral blood flow on mean arterial pressure in patients with acute bacterial meningitis. Crit Care Med 28:1027–1032
Paulson OB, Brodersen P, Hansen EL, Kristensen HS (1974) Regional cerebral blood flow, cerebral metabolic rate of oxygen, and cerebrospinal fluid acid-base variables in patients with acute meningitis and with acute encephalitis. Acta Med Scand 196:191–198
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Depreitere, B., Bruyninckx, D., Güiza, F. (2016). Monitoring of Intracranial Pressure in Meningitis. In: Ang, BT. (eds) Intracranial Pressure and Brain Monitoring XV. Acta Neurochirurgica Supplement, vol 122. Springer, Cham. https://doi.org/10.1007/978-3-319-22533-3_20
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