Intra-arterial vasodilator therapy for parainfectious cerebral vasospasm

Ather Taqui, Lauren Koffman, Ferdinand Hui, Joao Gomes, M. Shazam Hussain, Mark Bain, Gabor Toth

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)225-229
Number of pages5
JournalJournal of the Neurological Sciences
Volume340
Issue number1-2
DOIs
Publication statusPublished - May 15 2014
Externally publishedYes

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Keywords

  • Endovascular
  • Infarct
  • Meningitis
  • Parainfectious
  • Vasculopathy
  • Vasodilator

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)

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