Fonseca Yudy, Tshimanga Taty, Ray Stephen, Malhotra Helen, Pongo Jean, Bodi Mabiala Joseph, Gushu Montfort Bernard, Phiri Tusekile, Chikaonda Bertha Mekiseni, Ambitapio Musungufu Davin, Uchama Mananu, O'Brien Nicole Fortier
Division of Critical Care Medicine, Department of Pediatrics, University of Maryland, Baltimore, MD, United States.
Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Front Neurol. 2021 Feb 12;11:558857. doi: 10.3389/fneur.2020.558857. eCollection 2020.
Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common. This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month-18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing. Forty-seven patients were analyzed. The majority had (36%) or (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, = 0.001). Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.
细菌性脑膜炎（BM）是一个全球性的公共卫生问题，会导致严重的发病率和死亡率。脑动脉狭窄会导致BM患者发生中风，并且可能适合进行干预。然而，在该疾病常见的资源有限地区，很难进行诊断。这是一项于2015年9月至2019年12月在撒哈拉以南非洲地区开展的前瞻性观察性研究。纳入了1个月至18岁脑脊液中存在嗜中性粒细胞增多或鉴定出细菌病原体的儿童。每天对大脑中动脉进行经颅多普勒超声（TCD）检查，目的是识别与血管狭窄一致的血流异常情况。对47例患者进行了分析。大多数患者患有（36%）或（36%）脑膜炎。10例（21%）患者入院时TCD正常。20例（43%）患者出现高血流且搏动指数（PI）正常，7例（15%）患者出现高血流且PI较低。10例（21%）患者出现低血流。所有TCD正常的儿童预后良好。TCD血流模式为高危（高血流/低PI或低血流）的患者更有可能预后不良（82%对38%，=0.001）。BM患儿中TCD血流模式异常很常见，并且能识别出神经预后不良的高危患儿。
