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Aktuelle Neurologie 2013; 40(02): 104-107
DOI: 10.1055/s-0032-1333225
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© Georg Thieme Verlag KG Stuttgart · New York

Duplexsonografie zum Nachweis zerebraler Gefäßkomplikationen bei bakterieller Meningitis

Detection of Cerebrovascular Complications in Bacterial Meningitis by Transcranial Colour-Coded Ultrasound
H. Kazarians
1   Neurologie, Asklepios Klinik Wandsbek, Hamburg
,
J. Rieper
1   Neurologie, Asklepios Klinik Wandsbek, Hamburg
,
C. Arning
1   Neurologie, Asklepios Klinik Wandsbek, Hamburg
› Author Affiliations
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Publication History

Publication Date:
09 January 2013 (online)

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Zusammenfassung

Die zerebrovaskuläre Beteiligung ist eine für die Prognose der bakteriellen Meningitis relevante Komplikation. Wir berichten über eine Patientin mit Pneumokokkenmeningitis, die unter laufender Therapie mit Antibiotika und Dexamethason eine Dysphasie entwickelte. Die zerebrale Kernspintomografie einschließlich time-of-flight-Angiografie blieb unauffällig. Mittels transkranieller Farbduplexsonografie konnten jedoch hochgradige Stenosen der Arteria cerebri media beidseits nachgewiesen werden, deren vollständige Rückbildung innerhalb von 14 Tagen macht Vasospasmen als Ursache der Stenosen wahrscheinlich. Unter Tripel-H-Therapie war die Dysphasie vollständig rückläufig. Der Fall zeigt die klinische Relevanz der Erkennung zerebraler Vasospasmen als wichtigen prognostischen Faktor bei bakterieller Meningitis. Spätestens mit Auftreten neurologischer Fokalsymptome sollte die transkranielle Farbduplexsonografie ergänzend eingesetzt werden, damit Risikopatienten vor Auftreten hämodynamischer Hirninfarkte identifiziert und der Verlauf der Vasospasmen kontrolliert werden können. Diagnostische und therapeutische Konsequenzen wären ein vaskuläres Monitoring mit konsequenter hypotonievermeidender Kreislaufstabilisierung.

Abstract

Cerebrovascular involvement like vasospasm is a common complication of bacterial meningitis and of high relevance concerning prognosis and outcome. In our case a patient with meningitis caused by Streptococcus pneumoniae developed a dysphasia, but no evidence of encephalitic, vascular or ischaemic involvement of the brain tissue could be demonstrated by magnetic resonance imaging and angiography, respectively. Transcranial colour-coded ultrasound then revealed a severe vasospasm of the middle cerebral artery. With hypertensive-hypervolemia-haemodilution therapy vasospasms and the neurological deficit improved consecutively. This case report underlines the relevance to detect cerebral vasospasms as a prognostic factor of bacterial meningitis. In addition, it demonstrates that transcranial ultrasound is of high importance as a diagnostic tool to detect and to monitor patients with bacterial meningitis, who are at risk for cerebral infarction caused by vasospasms, if haemodynamic alterations of cerebral blood flow occur. In clinical consequence, these patients must be monitored carefully to avoid hypotonic dysregulation of arterial blood pressure and can be treated by hypertensive-hypervolemia-haemodilution therapy if necessary.

Schlüsselwörter

bakterielle Meningitis - zerebrovaskuläre ­Erkrankungen - transkranieller Ultraschall - Hämodynamik - Vasospasmus

Keywords

bacterial meningitis - cerebrovascular disease - transcranial ultrasound - haemodynamics - vasospasm
 

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