| Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis. | |
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MedLine Citation:
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PMID: 12242556 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Computed tomography (CT) of the brain is recommended for assessment of intracranial pressure (ICP) of patients with acute bacterial meningitis who are comatose or show focal neurological deficits. The aim of this report is to draw attention to the possibility of a discrepancy between CT findings and ICP values in some patients with pneumococcal meningitis. METHODS: We describe three adult patients with pneumococcal meningitis who had both successive CT examinations and ICP measurements at the time of clinically evident cerebral herniation (n = 2) and/or prolonged coma (n = 2). RESULTS: Although measurements with a ventriculostomy catheter indicated that all three patients had severely raised ICP values of 90, 44, and 45 mmHg, repeated cranial CT greatly underestimated true ICP values. Despite clinical evidence of acute cerebral herniation, it was not detected in the contemporary CT findings of two patients. Continuous ICP monitoring in the ICU helped to guide treatment for increased ICP; nevertheless, two patients died. CONCLUSIONS: The clinician must be aware that cranial CT may fail to rule out the possibility of severely raised ICP or cerebral herniation in a patient with pneumococcal meningitis. Therefore, ICP monitoring of patients with bacterial (especially pneumococcal) meningitis who are in prolonged coma should be considered early and regardless of the cranial CT appearances. |
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Authors:
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Frank Winkler; Stefan Kastenbauer; Tarek A Yousry; Ulrich Maerz; Hans-W Pfister |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of neurology Volume: 249 ISSN: 0340-5354 ISO Abbreviation: J. Neurol. Publication Date: 2002 Sep |
Date Detail:
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Created Date: 2002-09-20 Completed Date: 2002-12-27 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0423161 Medline TA: J Neurol Country: Germany |
Other Details:
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Languages: eng Pagination: 1292-7 Citation Subset: IM |
Affiliation:
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Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistr. 15, 81377 Munich, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Female Humans Intracranial Hypertension / diagnosis, radiography*, surgery* Male Meningitis, Pneumococcal / diagnosis, radiography*, surgery* Middle Aged Tomography, X-Ray Computed / methods* Ventriculostomy / methods* |
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