title: Bedside evaluation of cerebral energy metabolism in severe community-acquired bacterial meningitis.
abstract: BACKGROUND
  Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate that this technique may separate ischemia and non-ischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis.
  
  
  METHODS
  Cerebral energy metabolism was monitored in 15 patients with severe community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio > 30 with intracerebral pyruvate level < 70 µmol L(-1). Non-ischemic mitochondrial dysfunction was defined as LP-ratio > 30 at a normal or increased interstitial concentration of pyruvate (≥ 70 μmol L(-1)). Patients with LP-ratios < 30 were classified as no mitochondrial dysfunction.
  
  
  RESULTS
  The biochemical pattern was in 8 patients (10 microdialysis catheters) classified as no mitochondrial dysfunction, in 5 patients classified as non-ischemic mitochondrial dysfunction, and in 2 patients (3 catheters) classified as ischemia.
  
  
  CONCLUSIONS
  In patients with severe community-acquired meningitis, compromised cerebral energy metabolism occurs frequently and was diagnosed in 7 out of 15 cases. A biochemical pattern of non-ischemic mitochondrial dysfunction appears to be a more common underlying condition than cerebral ischemia.
authors.affiliation: Department of Neurosurgery, Odense University Hospital, Odense, Denmark.
authors.forename: Frantz R
authors.initials: FR
authors.lastname: Poulsen
authors.forename: Mette
authors.initials: M
authors.lastname: Schulz
authors.forename: Anne
authors.initials: A
authors.lastname: Jacobsen
authors.forename: Åse B
authors.initials: ÅB
authors.lastname: Andersen
authors.forename: Lykke
authors.initials: L
authors.lastname: Larsen
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Schalén
authors.forename: Troels H
authors.initials: TH
authors.lastname: Nielsen
authors.forename: Carl-Henrik
authors.initials: CH
authors.lastname: Nordström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious; D004734:Energy Metabolism / Q000502:physiology*; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000378:metabolism*; D016920:Meningitis, Bacterial / Q000378:metabolism*; D017551:Microdialysis; D008875:Middle Aged; D028361:Mitochondrial Diseases / Q000378:metabolism*; D019289:Pyruvic Acid / Q000378:metabolism*; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D019289:Pyruvic Acid