Müller M, Merkelbach S, Schimrigk K
Department of Neurology, Saarland University Hospital, Homburg/Saar.
Acta Neurol Scand. 1996 Jun;93(6):443-9. doi: 10.1111/j.1600-0404.1996.tb00024.x.
Stenoses of the middle and anterior cerebral artery (MCA,ACA) are a clinical relevant complication of bacterial meningitis. We examined the involvement of the posterior cerebral (PCA) and of the basilar artery (BA) into the inflammatory process.
MATERIAL & METHODS: 39 unselected patients (26 men, 13 women; mean +/- SD age, 49 +/- 17 years) with bacterial (n = 37) and fungal (n = 2) meningitis underwent serial transcranial Doppler sonography recordings of the mean blood velocity (MBV) and the pulsatility index (PI) in the MCA, ACA and PCA, in the BA and in the submandibular internal carotid artery on Days 1, 3, 5, 8, 14 and 21 after admission. The results of the PCA and of the BA were compared to normal reference values and correlated to corresponding neurological signs. The criterion to assume a stenosis was: for the BA an MBV > or = 95 cm/s, for the PCA an MBV > or = 85 cm/s.
Compared with the controls MBV in both arteries was normal on Days 1 and 8-21, but significantly increased on Days 3 and 5. The PI was significantly increased in the BA on all days and in the PCA on Days 1 and 8-21. Stenoses of the PCA (4 of 43) and of the BA (4 of 32) remained without corresponding neurological signs, and occurred only in patients with two or more narrowed arteries of the anterior circulation (p < 0.05).
In bacterial meningitis, hemodynamic disturbances in the posterior circulation are less severe than in the anterior circulation and are clinically well tolerated.
大脑中动脉（MCA）和大脑前动脉（ACA）狭窄是细菌性脑膜炎的一种临床相关并发症。我们研究了大脑后动脉（PCA）和基底动脉（BA）在炎症过程中的受累情况。
39例未经挑选的细菌性（n = 37）和真菌性（n = 2）脑膜炎患者（26例男性，13例女性；平均年龄±标准差，49±17岁）在入院后第1、3、5、8、14和21天接受了MCA、ACA和PCA、BA以及下颌下颈内动脉平均血流速度（MBV）和搏动指数（PI）的系列经颅多普勒超声记录。将PCA和BA的结果与正常参考值进行比较，并与相应的神经系统体征相关联。假设存在狭窄的标准为：BA的MBV≥95 cm/s，PCA的MBV≥85 cm/s。
与对照组相比，两条动脉的MBV在第1天和第8 - 21天正常，但在第3天和第5天显著增加。BA在所有天数以及PCA在第1天和第8 - 21天的PI显著增加。PCA（43例中有4例）和BA（32例中有4例）的狭窄没有相应的神经系统体征，且仅发生在前循环有两条或更多动脉狭窄的患者中（p < 0.05）。
在细菌性脑膜炎中，后循环的血流动力学紊乱不如前循环严重，且在临床上耐受性良好。
