Transcranial Doppler Ultrasonographic Evaluation of Cerebrovascular Abnormalities in Children With Acute Bacterial Meningitis

Abstract

Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common.Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month−18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing.Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001).Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.

Transcranial Doppler Ultrasound, a Review for the Pediatric Intensivist

“…In children with cerebral malaria, those with a normal neurologic outcome had a higher THRR compared to those with poor neurologic outcome (1.09 vs. 0.98, p ≤ 0.001) [ 23 ]. This finding was also present in children with bacterial meningitis (THRR of 1.12 ± 0.06 for children with a good neurologic outcome vs. 0.98 ± 0.05 for those with a poor neurologic outcome, p = 0.03) [ 22 ].…”

“…As opposed to solely reporting CBFV, there has been some use of reporting patterns seen on TCD. In a study of 47 African children with bacterial meningitis without sickle cell anemia or cerebral malaria, children were divided into categories based on TCD CBFV and the PI [ 22 ]. In the normal-flow category, TCD values were within 2 standard deviations of age-based normative values whereas in the high flow group Vs, Vm were > 2 SD above normative value and further categorized based upon PI being abnormally low (PI < 0.6), normal (PI 0.6–1.3), or abnormally high (PI > 1.3).…”

Transcranial Doppler ultrasonography in bacterial meningitis: A systematic review

“…One study did not specify the sex of the participants. 13 Five studies included pediatrics in their study 2,9,11,13,14 while the remaining studies strictly enrolled adult participants.…”

“…Bacterial meningitis remains an important global health problem due to its high mortality despite optimal antibacterial therapy. 1,2 Across the globe, it is estimated that over 1.2 million cases of bacterial meningitis are reported annually. 3 While some patients may die from shock and other complications within hours of symptom onset, others may develop various complications and increase mortality, especially when antibiotics administration is significantly delayed.…”

Transcranial doppler velocities in a large healthy population of African children

“…Furthermore, as a result of its favorable attributes and the lack of alternate, available neuroimaging techniques, TCD is increasingly being used in the management of African children with sickle cell disease, obstructive hydrocephalus, sinus venous thrombosis, meningitis and cerebral malaria [ [5] , [6] , [7] , [8] , [9] , [10] ]. The interpretation of TCD examinations in this context is particularly problematic given the complete absence of normative data in African children.…”