The Use of Clinical Scales in Depicting Cerebrovascular Complications in Bacterial Meningitis

Abstract

To evaluate the utility of different scales for clinical assessment, over time, in acute bacterial meningitis, the authors investigated 53 consecutive patients (mean age 53 +/- 17 years). Clinical status on days 1, 3, 5, 8, and 14 after admission was determined by the Scandinavian Stroke Scale (SSS), Glasgow Coma Scale (GCS), and Hunt and Hess Scale (HH), and, on day 21, by the Glasgow Outcome Scale (GOS). Transcranial Doppler examinations were performed serially to assess for disease-related arterial narrowing. This was observed in 27 patients (51%) within 2 weeks of admission. All scales were observed to correlate with the 21-day GOS. Patients with cerebral arterial narrowing had significantly decreased SSS scores between days 1 and 8 and worse GCS and HH scores between days 3 and 5. Mean blood flow velocity in the middle cerebral artery on days 5 and 8 significantly correlated with GOS (r = 0.268, P < .008; r = -0.324, P < .003, respectively). The use of such clinical scales allows standardized assessment of patients with bacterial meningitis and provides prognostic information. Cerebral arterial narrowing was observed to correlate with neurologic impairment.

Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis

“…Here, we detected an increase of systolic CBFv greater than 150 cm/s in 41 of 94 patients (43.6%) with acute bacterial meningitis. In earlier smaller case series, similar rates have been reported: for example, an increase of the CBFv was found in 23 of 41 patients (51%) with acute bacterial meningitis [11] and in 27 of 53 (51%) patients with bacterial meningitis during the first two weeks of admission [12]. Also, a very high incidence of vascular alterations was reported in a case series of 22 patients with bacterial meningitis, with markedly increased systolic peak velocities (> 210 cm/s) in seven patients [13].…”

Transcranial Doppler ultrasonography in bacterial meningitis: A systematic review

“…14 PI values were elevated in 9%, 10 37%, 13 and 38% patients consistent with an increased intracranial pressure. 9 Arterial stenosis were documented in 50%, 11 51%, 8,12 and 82% 10 patients with a predilection of the MCA. 8 Intracranial vasospasm was also evident on the 3rd to 5th day but it did not specify the exact vessel.…”

“…Majority of the patients included in the studies were identified to have bacterial meningitis, while some studies included those with fungal [8][9][10]12,13 and viral 11 Four studies correlated TCD monitoring findings with Glasgow Coma Scale (GCS), 8,9,11,12 while five studies correlated the outcomes with the Glasgow Outcomes Scale (GOS) 8,9,11,12,14 One study also determined the clinical status by the Scandinavian Stroke Scale (SSS) and the Hunt and Hess Scale (HH). 12 TCD findings were commonly assessed within 12 h after admission and serially on days 1, 3, 5, 8, 14, and 21.…”

“…Majority of the patients included in the studies were identified to have bacterial meningitis, while some studies included those with fungal [8][9][10]12,13 and viral 11 Four studies correlated TCD monitoring findings with Glasgow Coma Scale (GCS), 8,9,11,12 while five studies correlated the outcomes with the Glasgow Outcomes Scale (GOS) 8,9,11,12,14 One study also determined the clinical status by the Scandinavian Stroke Scale (SSS) and the Hunt and Hess Scale (HH). 12 TCD findings were commonly assessed within 12 h after admission and serially on days 1, 3, 5, 8, 14, and 21. TCD devices varied among the studies, including the following: TC 2-64, EME (Überlingen, Germany); DWL (Sipplingen, Germany) Multidop X; 2 or 4 MHz probe (Multi-Dop X, DWL Elektronische Systeme GmbH, Uberlingen, Germany); 3.5 and 5 MHz transducers with an EUB 515 A scanner (Hitachi, Tokyo, Japan); SonaraTek Digital TCD, CareFusion, Middleton, WI or Lucid TCD, Neural Analytics, Los Angeles, CA.…”

“…There was a consistent elevation of MFV which is consistent with hyperemia that dramatically increased between days 3 and 8. 8,[10][11][12][13]15 Hyperemia was also present in 63% of the cases but did not specify the exact day of the illness. 14 PI values were elevated in 9%, 10 37%, 13 and 38% patients consistent with an increased intracranial pressure.…”