The role of ICP monitoring in meningitis

Abstract

Intracranial pressure (ICP) monitoring has been widely accepted in the management of traumatic brain injury. However, its use in other pathologies that affect ICP has not been advocated as strongly, especially in CNS infections. Despite the most aggressive and novel antimicrobial therapies for meningitis, the mortality rate associated with this disease is far from satisfactory. Although intracranial hypertension and subsequent death have long been known to complicate meningitis, no specific guidelines targeting ICP monitoring are available. A review of the literature was performed to understand the pathophysiology of elevated ICP in meningitis, diagnostic challenges, and clinical outcomes in the use of ICP monitoring.

Keywords: BBB = blood-brain barrier; CBF = cerebral blood flow; CFR = case fatality rate; COX = cyclooxygenase; CPP = cerebral perfusion pressure; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IL = interleukin; NO = nitric oxide; PG = prostaglandin; RR = relative risk; SAS = subarachnoid space; TNF = tumor necrosis factor; cerebrospinal fluid; critical care; intracranial pressure; meningitis.