%0 Journal Article
%T Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis
%A Matthias Klein
%A Uwe Koedel
%A Thomas Pfefferkorn
%A Grete Zeller
%A Bianca Woehrl
%A Hans-Walter Pfister
%J Critical Care
%D 2011
%I BioMed Central
%R 10.1186/cc10565
%X We retrospectively studied patients with acute bacterial meningitis who were treated in our university hospital from 2000 to 2009. Data were analyzed with the main focus on the incidence of an increase of CBFv on TCD, defined as peak systolic values above 150 cm/s, and the development of stroke.In total, 114 patients with acute bacterial meningitis were treated, 94 of them received routine TCD studies during their hospital stay. 41/94 patients had elevated CBFv values. This increase was associated with an increased risk of stroke (odds ratio (95% confidence intervall) = 9.15 (1.96-42.67); p < 0.001) and unfavorable outcome (Glasgow Outcome Score < 4; odds ratio (95% confidence intervall) = 2.93 (1.23-6.98); p = 0.018). 11/32 (34.4%) patients with an increase of CBFv who received nimodipine and 2/9 (22.2%) patients with an increase of CBFv who did not receive nimodipine developed stroke (p = 0.69).In summary, TCD was found to be a valuable bedside test to detect arterial alterations in patients with bacterial meningitis. These patients have an increased risk of stroke.The development of cerebrovascular alterations is an important intracranial complication in acute bacterial meningitis and is associated with poor outcome [1]. Arterial cerebrovascular complications are reported to occur in approximately one-fifth of patients [2]. Using digital subtraction angiography (DSA), arterial narrowing is the predominant finding in patients with arterial complications, involving all vessel sizes [1]. The underlying reason for narrowing of the cerebral arteries during bacterial meningitis is still a matter of debate. Autopsy and animal model studies indicate severe inflammation of the vessel walls (vasculitis) as a key etiology [3,4]. Furthermore, patients in whom histopathological correlates in terms of inflammation were not found at the sites of arterial narrowing have been reported [5,6]. This suggests vasospasm as a second important etiology. Also, ischemic stroke can occur a
%U http://ccforum.com/content/15/6/R281