Müller M, Merkelbach S, Hermes M, König J, Schimrigk K
Department of Neurology, University Hospital of the Saarland, Homburg/Saar, Germany.
J Neurol. 1998 Feb;245(2):87-92. doi: 10.1007/s004150050183.
To evaluate the influence of cerebral artery stenosis on the outcome of patients with bacterial meningitis we examined prospectively 47 consecutive patients [33 men, 14 women, mean (SD) age, 53 (17) years, range 18-81] with bacterial meningitis caused by various bacterial pathogens. The patients were examined with the use of the Glasgow Coma Scale (GCS) on days 1, 3, 5, 8, 14 and with the use of the Glasgow Outcome Scale (GOS) on day 21 after admission. In addition, focal cerebral signs were recorded separately. At each clinical examination, the patients underwent transcranial Doppler sonography recordings of the mean blood velocity (MBV) and the pulsatility index in all of the main intracranial arteries and in the submandibular internal carotid artery (ICA). A stenosis of the middle cerebral artery (MCA) was diagnosed by an MBV of > or = 120 cm/s or by an MBV ratio > 3 between the MCA and the ICA. An anterior cerebral artery (ACA) stenosis was indicated by an MBV > or = 100 cm/s, a posterior cerebral artery (PCA) stenosis by an MBV of > or = 85 cm/s, and a basilar artery (BA) stenosis by an MBV of > or = 95 cm/s. Twenty-five patients developed stenosis of the cerebral arteries (apart from 1, all within 8 days), 22 patients remained without stenosis. Of 29 focal cerebral signs, 27 occurred within 8 days. For outcome analysis, outcome was classified into two groups: not handicapped (GOS 5) versus handicapped (GOS 2-4) and dead (GOS 1). Based on the disease course up to day 8, risk factors for a handicapped/dead outcome after day 8 were advancing age (odds ratio per year, 1.06; 95% confidence interval (CI), 1.01-1.11; P = 0.03) and the presence of arterial stenosis (odds ratio, 7.3; 95% CI, 1.1-45) using a multivariate logistic regression analysis model. GCS on day 1, cerebrospinal fluid total protein content and the presence of focal cerebral signs were not significantly related to outcome in this series. The patients with stenosis exhibited significantly more frequently a poorer GCS on days 1-5 (Mann-Whitney U test; P < 0.05). In conclusion, the early occurrence of stenosis of the cerebral arteries in bacterial meningitis predicted a worse clinical course of the disease and a poorer short-term outcome of the survivors.
为评估脑动脉狭窄对细菌性脑膜炎患者预后的影响，我们对47例连续的细菌性脑膜炎患者进行了前瞻性研究[33例男性，14例女性，平均（标准差）年龄53（17）岁，范围18 - 81岁]，这些患者由各种细菌病原体引起。在入院第1、3、5、8、14天使用格拉斯哥昏迷量表（GCS）对患者进行检查，并在入院后第21天使用格拉斯哥预后量表（GOS）进行检查。此外，分别记录局灶性脑体征。在每次临床检查时，对患者所有主要颅内动脉及下颌下颈内动脉（ICA）进行经颅多普勒超声记录平均血流速度（MBV）和搏动指数。大脑中动脉（MCA）狭窄通过MBV≥120 cm/s或MCA与ICA之间的MBV比值>3来诊断。大脑前动脉（ACA）狭窄通过MBV≥100 cm/s提示，大脑后动脉（PCA）狭窄通过MBV≥85 cm/s提示，基底动脉（BA）狭窄通过MBV≥95 cm/s提示。25例患者出现脑动脉狭窄（除1例外在8天内全部出现），22例患者未出现狭窄。在29例局灶性脑体征中，27例在8天内出现。为进行预后分析，将预后分为两组：无残疾（GOS 5）与残疾（GOS 2 - 4）及死亡（GOS 1）。根据直至第8天的病程，使用多因素逻辑回归分析模型，8天后残疾/死亡预后的危险因素为年龄增长（每年优势比1.06；95%置信区间（CI），1.01 - 1.11；P = 0.03）和存在动脉狭窄（优势比，7.3；95% CI，1.1 - 45）。在本系列中，第1天的GCS、脑脊液总蛋白含量和局灶性脑体征的存在与预后无显著相关性。出现狭窄的患者在第1 - 5天GCS较差的情况显著更频繁（曼 - 惠特尼U检验；P < 0.05）。总之，细菌性脑膜炎中脑动脉狭窄的早期出现预示着疾病的临床病程更差以及幸存者的短期预后更差。
