CEREBROVASCULAR INVOLVEMENT IN THE ACUTE-PHASE OF BACTERIAL-MENINGITIS

Cerebral ischaemia is a common complication of bacterial meningitis. A lthough cerebrovascular involvement in the acute phase of inflammation may be particularly important for the still unacceptably high morbidi ty and mortality, only, a few studies have investigated cerebrovascula r changes in bacterial meningitis. We prospectively investigated chang es of intracranial cerebral blood flow velocities (CBFV) in 22 patient s (12 men, 10 women, mean age 48 years, 19 years, SD) with bacterial m eningitis, by means of transcranial Doppler sonography (TCD). Accordin g to previously published criteria the degree of arterial narrowing wa s assessed and related to the patients' outcome. Elevated CBFVs in the middle cerebral artery were documented in 18/22 patients with markedl y increased systolic peak velocities (CBFV of > 210 cm/s) in 7 patient s. Serial examinations performed in 11 patients showed elevated CBFV a s early as day 1, reaching peak CBFV between day 3 and day 6 after ons et of symptoms in most cases. Furthermore, cerebrovascular involvement was also documented by disturbances of physiological slow spontaneous oscillations of blood now velocities in 5/10 patients examined with T CD. Low Glasgow Coma Scales (< 7) on admission (29% vs 0%), focal cere bral ischaemic deficits (29% vs 7%) and, seizures (43% vs 7%) were mor e frequent in patients with CBFV of > 210 cm/s. Finally, a poor clinic al outcome was significantly related to severe vascular involvement (P < 0.05). In conclusion, cerebrovascular complications are frequently found in patients with bacterial meningitis. TCD is an easily applicab le technique for revealing vascular changes non-invasively, even in se verely ill patients. Since our data suggest an unfavourable course of the disease in association with increased CBFV in intracranial arterie s, probably indicating vasospasm, TCD could potentially be used to ide ntify high-risk patients who could benefit from adjuvant therapeutic i nterventions.