The role of ICP monitoring in meningitis

Tariq, Areej; Aguilar‐Salinas, Pedro; Hanel, Ricardó A.; Naval, Neeraj S.; Chmayssani, Mohamad

doi:10.3171/2017.8.focus17419

Cited by 40 publications

(21 citation statements)

References 53 publications

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“…Thus, IICP is associated with mortality in meningitis patients and affects the course and prognosis of the disease [ 30 , 32 ]. Therefore, controlling IICP can improve the prognosis [ 33 , 34 ]. The opening pressure in meningitis is associated with the severity of the disease, and in our study, the CSF VDBP level was higher in patients with CNS infections with high opening pressure (> 25 cmH 2 O) than in patients with CNS infections with low opening pressure (≤25 cmH 2 O).…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections

Kim

Lê

et al. 2021

BMC Infect Dis

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Background Rapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections. Even when the patient has symptoms, laboratory tests often do not reveal any specific findings. The potential of vitamin D-binding protein (VDBP) to be used as a biomarker for viral and bacterial CNS infections was studied. Methods A total of 302 subjects with suspected CNS infection who underwent lumbar puncture were included. Clinical and laboratory data were collected retrospectively. VDBP levels were measured in the cerebrospinal fluid (CSF) samples. Genotyping for the GC gene encoding VDBP was also performed. VDBP levels were analyzed and compared by CNS infection, pathogen, CSF opening pressure, and GC genotype. Results A CNS infection group (n = 90) and a non-CNS infection group (n = 212) were studied. In terms of its receiver operating characteristic, CSF VDBP showed an area under the curve of 0.726 for the diagnosis of CNS infection. CSF VDBP levels were significantly different between the CNS infection and non-infection groups. The CNS infection group with enterovirus showed a statistically lower distribution of CSF VDBP levels than the other virus groups. The group with CSF opening pressure > 25 cmH2O showed higher CSF VDBP levels than the other groups. There was no significant difference in GC gene allele distribution between the CNS infection and non-infection groups. Conclusions CSF VDBP levels were increased in patients with CNS infection. The CSF VDBP showed potential as a new biomarker for viral and bacterial CNS infections.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections

Kim

Lê

et al. 2021

BMC Infect Dis

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“…The impossibility of using invasive instrumental methods for determining the state of cerebral circulation and its autoregulation in patients with a non-surgical profile, patients with infections of the central nervous system, leads to a significant limitation of both fundamental ideas about the mechanisms of its secondary damage in this contingent of patients and the substantiation of purposeful, pathogenetically substantiated intensive therapy. It should be noted that individual studies confirm that monitoring intracranial pressure reduces the mortality of patients with meningitis (Tariq et al, 2017). Thus, non-invasive (ultrasound) methods of monitoring ICP and CPP can be the basis for an in-depth study of the features of hemodynamics and cerebrovascular disorders, cerebral perfusion, its autoregulation, the presence or absence of the phenomenon of cerebral vasospasm.…”

Section: Discussionmentioning

confidence: 99%

“…The results obtained by us are one of the first attempts to use ultrasound dopplerographic methods for the determination of cerebral flow in children with central nervous system infections in an intensive care unit. Extremely invasive methods of control were used in close-up content work devoted to the intensive care of neuroinfections (Kumar et al, 2014;Tariq et al, 2017). At the same time, the vast majority of publications devoted to the study of cerebral flow by non-invasive ultrasound methods refer to neurosurgical patients, mostly adults (Alali et al, 2015;O'Brien et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

Georgiynts

Корсунов

Ольховська

et al. 2018

Regul. Mech. Biosyst.

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The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.

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“…Although high ICP is a common observation in acute brain injury, hydrocephalus, or bacterial meningitis [10], in certain disorders such as liver failure, extremely elevated ICP may be observed [8]. In cryptococcal meningitis, a lumbar cerebrospinal fluid (CSF) opening pressure of > 25 mmHg was negatively associated with long-term survival.…”

Section: Background and Importancementioning

confidence: 99%

Extreme intracranial pressure elevation > 90 mmHg in an awake patient with primary CNS lymphoma—case report

2020

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We describe a patient with primary CNS lymphomas, awake despite an extreme ICP elevation. A 48-year-old woman presented with headache since 1 month, and bilateral papillary edema was observed. Magnetic resonance imaging revealed diffuse infiltration around the petrous bone. Following external ventricular drainage (EVD) placement, ICP levels of > 90 mmHg were recorded while the patient was fully awake. Cytology revealed an aggressive primary CNS lymphoma. Cerebrospinal fluid (CSF) drainage at high opening pressure levels was required. We conclude that extreme ICP elevations, treatable by CSF drainage, can be observed without a reduced level of consciousness.

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The role of ICP monitoring in meningitis

Cited by 40 publications

References 53 publications

Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections

Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections

Non-invasive evaluation of cerebral hemodynamic and intracranial pressure in pediatric neuroinfections

Extreme intracranial pressure elevation > 90 mmHg in an awake patient with primary CNS lymphoma—case report

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