Naija Walid, Matéo Joaquim, Raskine Laurent, Timsit Jean-François, Lukascewicz Anne-Claire, George Bernard, Payen Didier, Mebazaa Alexandre
Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France.
Crit Care. 2004 Dec;8(6):R491-4. doi: 10.1186/cc2972. Epub 2004 Oct 27.
Differences in the composition of ventricular and lumbar cerebrospinal fluid (CSF) based on single pairs of samples have previously been described. We describe a patient that developed post-surgical recurrent meningitis monitored by daily biochemical and bacteriological CSF analysis, simultaneously withdrawn from lumbar space and ventricles. A 20-year-old Caucasian man was admitted to the ICU after a resection of a chordoma that extended from the sphenoidal sinus to the anterior face of C2. CSF was continuously leaking into the pharyngeal cavity after surgery, and three episodes of recurrent meningitis, all due to Pseudomonas aeruginosa O12, occurred. Our case showed permanent ventricular-to-lumbar CSF gradients of leukocytes, protein and glucose that were increased during the acute phase of meningitis, with the greatest amplitude being observed when bacteria were present in both ventricular and lumbar CSF. This might suggest a greater extent of meningeal inflammation in the lumbar than in the ventricular region. Our case also showed that the increase in intravenous antibiotics (cefepim from 8 to 12 g/day and ciprofloxacine from 1.2 to 2.4 g/day) led to an increase in concentration in plasma but not in CSF.
此前已有基于单对样本描述的脑室和腰椎脑脊液（CSF）成分差异。我们描述了一名患者，其在接受手术切除从蝶窦延伸至C2前面的脊索瘤后发生术后复发性脑膜炎，通过每日对同时从腰椎间隙和脑室抽取的脑脊液进行生化和细菌学分析进行监测。一名20岁的白种男性在切除脊索瘤后入住重症监护病房，该脊索瘤从蝶窦延伸至C2前面。术后脑脊液持续漏入咽腔，并发生了3次复发性脑膜炎发作，均由铜绿假单胞菌O12引起。我们的病例显示白细胞、蛋白质和葡萄糖在脑室与腰椎脑脊液之间存在永久性梯度，在脑膜炎急性期升高，当脑室和腰椎脑脊液中均有细菌时幅度最大。这可能表明腰椎部位的脑膜炎症程度比脑室区域更严重。我们的病例还显示静脉注射抗生素（头孢吡肟从8克/天增加至12克/天，环丙沙星从1.2克/天增加至2.4克/天）用量增加导致血浆浓度升高，但脑脊液浓度未升高。
