Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninistr, 15, D-81377 Munich, Germany.
Crit Care. 2011;15(6):R281. doi: 10.1186/cc10565. Epub 2011 Nov 23.
Intracranial vascular complications are an important complication of acute bacterial meningitis. Ischemic stroke in meningitis is reported as a result of vasculitis, vasospasm, endocarditis or intraarterial thrombosis. The aim of the study was to identify the value of measuring cerebral blood flow velocity (CBFv) on transracranial doppler (TCD) in the identification of patients at risk for meningitis-associated stroke.
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.
颅内血管并发症是急性细菌性脑膜炎的一个重要并发症。据报道，脑膜炎中的缺血性中风是由于血管炎、血管痉挛、心内膜炎或动脉内血栓形成引起的。本研究的目的是确定经颅多普勒（TCD）测量脑血流速度（CBFv）在识别脑膜炎相关中风风险患者中的价值。
我们回顾性研究了 2000 年至 2009 年在我们大学医院治疗的急性细菌性脑膜炎患者。主要关注 TCD 上 CBFv 升高（定义为收缩期峰值超过 150cm/s）的发生率和中风的发生。
共有 114 例急性细菌性脑膜炎患者接受治疗，其中 94 例在住院期间接受常规 TCD 检查。41/94 例患者的 CBFv 值升高。这种增加与中风的风险增加相关（优势比（95%置信区间）= 9.15（1.96-42.67）；p < 0.001）和不良预后（格拉斯哥预后评分<4；优势比（95%置信区间）= 2.93（1.23-6.98）；p = 0.018）。11/32（34.4%）接受尼莫地平治疗的 CBFv 升高患者和 2/9（22.2%）未接受尼莫地平治疗的 CBFv 升高患者发生中风（p = 0.69）。
总之，TCD 被发现是一种有价值的床边检测方法，可用于检测细菌性脑膜炎患者的动脉改变。这些患者中风风险增加。
