The value of transcranial Doppler imaging in children with tuberculous meningitis
| Autor: | J A Laubscher, Johan F. Schoeman, Regan Solomons, H. Simon Schaaf, Ronald van Toorn |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Ultrasonography Doppler Transcranial Pulsatility index Doppler imaging Tuberculous meningitis Raised intracranial pressure Time medicine Humans Child Vasculitis Central Nervous System Intracranial pressure Retrospective Studies business.industry General Medicine Mycobacterium tuberculosis medicine.disease Magnetic Resonance Imaging Surgery Transcranial Doppler Tuberculosis Meningeal Pediatrics Perinatology and Child Health cardiovascular system Female Neurology (clinical) Neurosurgery Radiology Intracranial Hypertension business circulatory and respiratory physiology |
| Zdroj: | Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 30(10) |
| ISSN: | 1433-0350 |
| Popis: | Transcranial Doppler imaging (TCDI) is potentially a valuable investigational tool in children with tuberculous meningitis (TBM), a condition often complicated by pathology relevant to Doppler imaging such as raised intracranial pressure (ICP) and cerebral vasculopathies.Serial TCDI was performed on 20 TBM children with the aim of investigating cerebrovascular haemodynamics and the relationship between pulsatility index (PI) and ICP.We observed a poor correlation between ICP and PI in children with communicating hydrocephalus (p = 0.72). No decline in PI was noted following 7 days of medical therapy for communicating hydrocephalus (p = 0.78) despite a concomitant decline in ICP. Conversely, a decline in PI was noted in all four children with non-communicating hydrocephalus who underwent cerebrospinal fluid diversion. High blood flow velocities (BFV) in all the basal cerebral arteries were observed in 14 children (70 %). The high BFV persisted for 7 days suggesting stenosis due to vasculitis rather than functional vasospasm. Complete middle cerebral artery (MCA) occlusion, subnormal mean MCA velocities (40 cm/s) and PIs (0.4) correlated with radiologically proven large cerebral infarcts.TCDI-derived PI is not a reliable indicator of raised ICP in children with tuberculous hydrocephalus. This may be attributed to individual variation of tuberculous vascular disease, possibly compromising cerebral vascular compliance and resistance. Basal artery stenosis secondary to vasculitis is observed during the acute stage of TBM in the majority of children. |
| Databáze: | OpenAIRE |
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