Intracranial pressure and cerebral perfusion pressure in experimental streptococcus pneumoniae meningitis.
Clinical studies have demonstrated the prognostic importance of increased intracranial pressure in central nervous system infections. To delineate development of intracranial pressure in meningitis experiments were carried out in rabbits. Meningitis was induced by injecting streptococcus pneumoniae bacteria into the cisterna magna and blood, and intracranial pressures were continuously recorded. In the experimental model, three stages were seen: incubation period (0-8 h)--in which CSF becomes positive for the infecting organism and biochemical changes occur, but there are no hemodynamic or intracranial pressure changes; stage of slowly increasing intracranial pressure - because blood pressure remains normal, cerebral perfusion pressure is maintained adequate for cerebral metabolic need (9-24 h); terminal stage (greater than 25 h)--with hemodynamic collapse, critical reduction of cerebral perfusion pressure, cerebral ischemia, and death of the experimental animals. It is suggested that a similar sequence occurs in human disease. The clinical implication stresses the need for early recognition and treatment of intracranial hypertension as an important adjunct to antibiotic treatment of the infecting organism.
Goitein
K J
KJ
Department of Pediatrics and Clinical Microbiology, Hadassah University Hospital, Jerusalem, Israel.
Shapiro
M
M
D000818:Animals; D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D004195:Disease Models, Animal; D007427:Intracranial Pressure; D008586:Meningitis, Pneumococcal / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D011817:Rabbits; D013997:Time Factors