title: Intra-arterial vasodilator therapy for parainfectious cerebral vasospasm.
abstract: Cerebrovascular complications of bacterial meningitis may include vasculitis, vasospasm or vasoconstriction, delayed cerebral infarction, venous and arterial thrombosis, intracranial aneurysm formation. The role of invasive endovascular therapies has not been well studied for infectious vasospasm, which can lead to dire neurologic consequences. We present 2 patients who were diagnosed with bacterial meningitis. Brain MRI showed areas of acute ischemia. Neurologic worsening was seen in both patients despite aggressive medical management. Follow-up imaging demonstrated significant narrowing of the intracranial vessels with associated new scattered infarcts. Both patients underwent targeted intra-arterial vasodilator infusion with angiographically improved vessel caliber and distal flow. The neurological exam subsequently stabilized in both cases. Follow-up radiographic images demonstrated no further ischemia in one of the 2 patients. Vasculopathy and vasospasm causing delayed ischemic neurologic deficit is a rare, but severe complication of acute meningitis. It can be a significant predictor of poor prognosis, and the disease may progress despite aggressive medical therapy. Although frequently used in subarachnoid hemorrhage-related vasospasm, to our knowledge, this is the first report of endovascular vasodilator treatment as adjunctive intervention in patients with meningitis associated vasculopathy.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ather
authors.initials: A
authors.lastname: Taqui
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Koffman
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hui
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Joao
authors.initials: J
authors.lastname: Gomes
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M Shazam
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bain
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA. Electronic address: tothg@ccf.org.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*
chemical_list: D014665:Vasodilator Agents
keywords: Endovascular; Infarct; Meningitis; Parainfectious; Vasculopathy; Vasodilator