The trigeminovascular system in bacterial meningitis

Hoffmann, Olaf; Dirnagl, Ulrich; Weber, Joerg R.

doi:10.1002/jemt.1083

Cited by 4 publications

(2 citation statements)

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“…In human and experimental meningitis, loss of function is due to both necrotic and apoptotic neuronal death, but the underlying pathophysiological mechanisms remain elusive [26,27]. Bacterial meningitis is associated with dilation of superficial cerebral blood vessels, increased blood flow, oedema and headache [28,29], which depend at least partly on substance P and prostaglandin action [30,31].…”

Section: Figure 1 Schematic View Of the Different (Peri)vascular Cellmentioning

confidence: 99%

(Peri)vascular production and action of pro-inflammatory cytokines in brain pathology

2006

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In response to tissue injury or infection, the peripheral tissue macrophage induces an inflammatory response through the release of IL-1beta (interleukin-1beta) and TNFalpha (tumour necrosis factor alpha). These cytokines stimulate macrophages and endothelial cells to express chemokines and adhesion molecules that attract leucocytes into the peripheral site of injury or infection. The aims of the present review are to (i) discuss the relevance of brain (peri)vascular cells and compartments to bacterial meningitis, HIV-1-associated dementia, multiple sclerosis, ischaemic and traumatic brain injury, and Alzheimer's disease, and (ii) to provide an overview of the production and action of pro-inflammatory cytokines by (peri)vascular cells in these pathologies of the CNS (central nervous system). The brain (peri)vascular compartments are highly relevant to pathologies affecting the CNS, as infections are almost exclusively blood-borne. Insults disrupt blood and energy flow to neurons, and active brain-to-blood transport mechanisms, which are the bottleneck in the clearance of unwanted molecules from the brain. Perivascular macrophages are the most reactive cell type and produce IL-1beta and TNFalpha after infection or injury to the CNS. The main cellular target for IL-1beta and TNFalpha produced in the brain (peri)vascular compartment is the endothelium, where these cytokines induce the expression of adhesion molecules and promote leucocyte infiltration. Whether this and other effects of IL-1 and TNF in the brain (peri)vascular compartments are detrimental or beneficial in neuropathology remains to be shown and requires a clear understanding of the role of these cytokines in both damaging and repair processes in the CNS.

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Section: Figure 1 Schematic View Of the Different (Peri)vascular Cellmentioning

confidence: 99%

(Peri)vascular production and action of pro-inflammatory cytokines in brain pathology

2006

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“…Pain management in meningitis combines adjunct measures and analgesic drugs (see ''Adjuvant Therapy'' section and Table 6). There is some interesting experimental evidence that activation of the trigeminal system in meningitis may, via release of proinflammatory cytokines (neurogenic inflammation), be harmful and an anti-inflammatory effect has been suggested when triptans have been given at an early stage [150]. There is evidence that the use of corticosteroids as an anti-inflammatory agent may be of benefit in meningitis [151].…”

Section: Meningitismentioning

confidence: 99%

Pain Management in Neurocritical Care

Petzold

Girbes

2013

Neurocrit Care

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The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. Many conditions predispose to the development of chronic pain. There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed.

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