INFLAMMATORY CYTOKINES IN CSF IN BACTERIAL-MENINGITIS - ASSOCIATION WITH ALTERED BLOOD-FLOW VELOCITIES IN BASAL CEREBRAL-ARTERIES

Objective-To investigate the association between release of humoral in flammatory mediators in CSF and blood and alterations of cerebral bloo d flow in patients with bacterial meningitis. Methods-Immunomodulatory (interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumour nec rosis factor-alpha (TNF alpha) and vasoactive (thromboxane A, prostacy clin, endothelin-1) molecules of probable or confirmed leucocyte origi n were determined in CSF and venous blood from 20 patients with bacter ial meningitis, and matched control subjects. Their concentrations wer e related to the presence of increased blood flow velocities in the mi ddle cerebral arteries, as recorded by transcranial Doppler sonography . Results-Concentrations of proinflammatory cytakines and prostacyclin and leucocyte counts were significantly increased in meningitis, but concentrations of the vasoconstrictors thromboxane and endothelin-l we re not. Patients with high blood flow velocities (> 140 cm/s) had sign ificantly increased concentrations of IL-1 beta and IL-6 and raised ce ll counts in CSF. Conclusion-The increases of key mediators of inflamm ation and immunoactivation and of leucocyte count in the CSF of patien ts with high cerebral blood flow velocities suggest a role of excessiv e compartmentalised host defence in pathogenesis of disorders of cereb ral blood flow in bacterial meningitis.