title: Case report: greater meningeal inflammation in lumbar than in ventricular region in human bacterial meningitis.
abstract: Differences in the composition of ventricular and lumbar cerebrospinal fluid (CSF) based on single pairs of samples have previously been described. We describe a patient that developed post-surgical recurrent meningitis monitored by daily biochemical and bacteriological CSF analysis, simultaneously withdrawn from lumbar space and ventricles. A 20-year-old Caucasian man was admitted to the ICU after a resection of a chordoma that extended from the sphenoidal sinus to the anterior face of C2. CSF was continuously leaking into the pharyngeal cavity after surgery, and three episodes of recurrent meningitis, all due to Pseudomonas aeruginosa O12, occurred. Our case showed permanent ventricular-to-lumbar CSF gradients of leukocytes, protein and glucose that were increased during the acute phase of meningitis, with the greatest amplitude being observed when bacteria were present in both ventricular and lumbar CSF. This might suggest a greater extent of meningeal inflammation in the lumbar than in the ventricular region. Our case also showed that the increase in intravenous antibiotics (cefepim from 8 to 12 g/day and ciprofloxacine from 1.2 to 2.4 g/day) led to an increase in concentration in plasma but not in CSF.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France.
authors.forename: Walid
authors.initials: W
authors.lastname: Naija
authors.forename: Joaquim
authors.initials: J
authors.lastname: Matéo
authors.forename: Laurent
authors.initials: L
authors.lastname: Raskine
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Lukascewicz
authors.forename: Bernard
authors.initials: B
authors.lastname: George
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002552:Cerebral Ventricles / Q000382:microbiology / Q000473:pathology*; D002557:Cerebrospinal Fluid Shunts; D002817:Chordoma / Q000150:complications / Q000601:surgery; D002939:Ciprofloxacin / Q000627:therapeutic use; D006801:Humans; D008161:Lumbosacral Region / Q000382:microbiology / Q000473:pathology*; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000601:surgery; D011552:Pseudomonas Infections / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012008:Recurrence; D013101:Sphenoid Sinus / Q000601:surgery; D013129:Spinal Puncture
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin