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    Transcranial Doppler Ultrasonographic Evaluation of Cerebrovascular Abnormalities in Children With Acute Bacterial Meningitis

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    Author
    Fonseca, Yudy
    Tshimanga, Taty
    Ray, Stephen
    Malhotra, Helen
    Pongo, Jean
    Bodi Mabiala, Joseph
    Gushu, Montfort Bernard
    Phiri, Tusekile
    Chikaonda, Bertha Mekiseni
    Ambitapio Musungufu, Davin
    Uchama, Mananu
    O'Brien, Nicole Fortier
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    Date
    2021-02-12
    Journal
    Frontiers in Neurology
    Publisher
    Frontiers Media S.A.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.3389/fneur.2020.558857
    Abstract
    Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common. Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month-18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing. Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001). Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.
    Rights/Terms
    Copyright © 2021 Fonseca, Tshimanga, Ray, Malhotra, Pongo, Bodi Mabiala, Gushu, Phiri, Chikaonda, Ambitapio Musungufu, Uchama and O'Brien.
    Keyword
    bacterial
    meningitis
    neurovascular
    pediatrics
    transcranial Doppler ultrasound
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14971
    ae974a485f413a2113503eed53cd6c53
    10.3389/fneur.2020.558857
    Scopus Count
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