Cerebral blood flow and carbon dioxide reactivity in children with bacterial meningitis

Journal Article · Mon Oct 01 04:00:00 EDT 1990 · Journal of Pediatrics; (USA)

DOI:https://doi.org/10.1016/S0022-3476(05)80683-3· OSTI ID:6282938

Ashwal, S; Stringer, W; Tomasi, L; Schneider, S; Thompson, J; Perkin, R ^[1]

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1. Loma Linda Univ. School of Medicine, CA (USA)

We examined total and regional cerebral blood flow (CBF) by stable xenon computed tomography in 20 seriously ill children with acute bacterial meningitis to determine whether CBF was reduced and to examine the changes in CBF during hyperventilation. In 13 children, total CBF was normal (62 +/- 20 ml/min/100 gm) but marked local variability of flow was seen. In five other children, total CBF was significantly reduced (26 +/- 10 ml/min/100 gm; p less than 0.05), with flow reduced more in white matter (8 +/- 5 ml/min/100 gm) than in gray matter (30 +/- 15 ml/min/100 gm). Autoregulation of CBF appeared to be present in these 18 children within a range of mean arterial blood pressure from 56 to 102 mm Hg. In the remaining two infants, brain dead within the first 24 hours, total flow was uniformly absent, averaging 3 +/- 3 ml/min/100 gm. In seven children, CBF was determined at two carbon dioxide tension (PCO2) levels: 40 (+/- 3) mm Hg and 29 (+/- 3) mm Hg. In six children, total CBF decreased 33%, from 52 (+/- 25) to 35 (+/- 15) ml/min/100 gm; the mean percentage of change in CBF per millimeter of mercury of PCO2 was 3.0%. Regional variability of perfusion to changes in PCO2 was marked in all six children. The percentage of change in CBF per millimeter of mercury of PCO2 was similar in frontal gray matter (3.1%) but higher in white matter (4.5%). In the seventh patient a paradoxical response was observed; total and regional CBF increased 25% after hyperventilation. Our findings demonstrate that (1) CBF in children with bacterial meningitis may be substantially decreased globally, with even more variability noted regionally, (2) autoregulation of CBF is preserved, (3) CBF/CO2 responsitivity varies among patients and in different regions of the brain in the same patient, and (4) hyperventilation can reduce CBF below ischemic thresholds.

• OSTI ID: 6282938
• Journal Information: Journal of Pediatrics; (USA), Journal Name: Journal of Pediatrics; (USA) Vol. 117:4; ISSN 0022-3476; ISSN JOPDA
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
AGE GROUPS
BACTERIAL DISEASES
BLOOD FLOW
BODY
BRAIN
CARBON COMPOUNDS
CARBON DIOXIDE
CARBON OXIDES
CENTRAL NERVOUS SYSTEM
CEREBRAL CORTEX
CEREBRUM
CHALCOGENIDES
CHILDREN
COMPUTERIZED TOMOGRAPHY
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
EMISSION COMPUTED TOMOGRAPHY
INFECTIOUS DISEASES
ISOTOPES
NERVOUS SYSTEM
ORGANS
OXIDES
OXYGEN COMPOUNDS
TOMOGRAPHY
XENON ISOTOPES