Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis

被引:45
作者
Winkler, F
Kastenbauer, S
Yousry, TA
Maerz, U
Pfister, HW
机构
[1] Univ Munich, Klinikum Grosshadern, Dept Neurol, D-81377 Munich, Germany
[2] Univ Munich, Klinikum Grosshadern, Dept Neuroradiol, D-81377 Munich, Germany
[3] Univ Munich, Klinikum Grosshadern, Dept Neurosurg, D-81377 Munich, Germany
关键词
bacterial meningitis; pneumococcal meningitis; intracranial pressure; CT;
D O I
10.1007/s00415-002-0844-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives Computed tomography (CT) of the brain is recommended for assessment of intracranial pressure (ICP) of patients with acute bacterial meningitis who are comatose or show focal neurological deficits. The aim of this report is to draw attention to the possibility of a discrepancy between CT findings and ICP values in some patients with pneumococcal meningitis. Methods We describe three adult patients with pneumococcal meningitis who had both successive CT examinations and ICP measurements at the time of clinically evident cerebral herniation (n = 2) and/or prolonged coma (n = 2). Results Although measurements with a ventriculostomy catheter indicated that all three patients had severely raised ICP values of 90,44, and 45 mmHg, repeated cranial CT greatly under-estimated true ICP values. Despite clinical evidence of acute cerebral herniation, it was not detected in the contemporary CT findings of two patients. Continuous ICP monitoring in the ICU helped to guide treatment for increased ICP; nevertheless, two patients died. Conclusions The clinician must be aware that cranial CT may fail to rule out the possibility of severely raised ICP or cerebral herniation in a patient with pneumococcal meningitis. Therefore, ICP monitoring of patients with bacterial (especially pneumococcal) meningitis who are in prolonged coma should be considered early and regardless of the cranial CT appearances.
引用
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页码:1292 / 1297
页数:6
相关论文
共 23 条
[21]   CT SCANNING IN MENINGITIS [J].
WARDLE, S ;
CARTY, H .
EUROPEAN JOURNAL OF RADIOLOGY, 1991, 12 (02) :113-119
[22]   Brain infarcts in adults with bacterial meningitis [J].
Weststrate, W ;
Hijdra, A ;
deGans, J .
LANCET, 1996, 347 (8998) :399-399
[23]  
WILLIAMS CPS, 1964, PEDIATRICS, P220