Müller M, Merkelbach S, Huss G P, Schimrigk K
Department of Neurology, University Hospital of the Saarland, Homburg/Saar, Germany.
Stroke. 1995 Aug;26(8):1399-403. doi: 10.1161/01.str.26.8.1399.
We sought to examine the frequency and clinical relevance of intracranial artery stenoses in patients with bacterial meningitis in whom the occurrence of stroke has angiographically been reported to be associated with stenoses or occlusions of the large basal cerebral arteries.
Thirty-five unselected patients (24 men, 11 women; mean age, 51 +/- 18 years) with bacterial (n = 33) or fungal (n = 2) meningitis prospectively underwent serial transcranial Doppler sonography recordings of mean blood velocity (MBV) and pulsatility index in the middle (MCA) and anterior (ACA) cerebral arteries, as well as recordings of the ratio of the MBV of the MCA and internal carotid artery (MCA/ICA ratio) on days 1, 3, 5, 8, 14, and 21 after admission. The results were correlated with the Glasgow Coma Scale (days 1 to 14), the occurrence of focal cerebral signs, and the Glasgow Outcome Scale (short-term outcome, day 21). An MCA stenosis was diagnosed by an MBV of 120 cm/s or more or an MCA/ICA ratio of more than 3. An ACA stenosis was diagnosed by an MBV of 100 cm/s or more.
Transient stenoses occurred most frequently between days 3 and 5 and were detected in 18 patients (51%). Seventeen patients remained without a stenosis. Patients with stenoses showed a significantly poorer mean Glasgow Coma Scale score from day 3 (9 +/- 4) to day 14 (11 +/- 4) than patients without a stenosis (day 3: 13 +/- 4, P < .01 by t test; day 14: 14 +/- 1, P < .05). The mean Glasgow Outcome Scale score was not significantly different between both groups. The occurrence of mainly transient focal cerebral signs was significantly related to the number of narrowed vessels per patient (P < .05, chi 2 test).
Stenoses of the intracranial arteries occur frequently in bacterial meningitis and are associated with a complicated course of the disease.
据血管造影报道，细菌性脑膜炎患者发生卒中与大脑基底大动脉狭窄或闭塞有关，我们试图研究此类患者颅内动脉狭窄的频率及临床相关性。
35例未经挑选的细菌性（n = 33）或真菌性（n = 2）脑膜炎患者（24例男性，11例女性；平均年龄51±18岁），在入院后第1、3、5、8、14和21天，前瞻性地接受了大脑中动脉（MCA）和大脑前动脉（ACA）平均血流速度（MBV）及搏动指数的系列经颅多普勒超声检查，以及MCA与颈内动脉MBV比值（MCA/ICA比值）的检查。结果与格拉斯哥昏迷量表（第1至14天）、局灶性脑体征的出现情况以及格拉斯哥预后量表（短期预后，第21天）相关。当MBV达到或超过120 cm/s或MCA/ICA比值超过3时，诊断为MCA狭窄。当MBV达到或超过100 cm/s时，诊断为ACA狭窄。
短暂性狭窄最常出现在第3至5天，18例患者（51%）检测到狭窄。17例患者未出现狭窄。与无狭窄的患者相比，有狭窄的患者从第3天（9±4）至第14天（11±4）的格拉斯哥昏迷量表平均评分明显更低（第3天：13±4，t检验P <.01；第14天：14±1，P <.05）。两组的格拉斯哥预后量表平均评分无显著差异。主要短暂性局灶性脑体征的出现与每位患者狭窄血管的数量显著相关（P <.05，卡方检验）。
颅内动脉狭窄在细菌性脑膜炎中频繁出现，并与疾病复杂的病程相关。
