Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 2/2015

01-04-2015 | Original Article

Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis

Authors: Frantz R. Poulsen, Mette Schulz, Anne Jacobsen, Åse B. Andersen, Lykke Larsen, Wilhelm Schalén, Troels H. Nielsen, Carl-Henrik Nordström

Published in: Neurocritical Care | Issue 2/2015

Login to get access

Abstract

Background

Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate that this technique may separate ischemia and non-ischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis.

Methods

Cerebral energy metabolism was monitored in 15 patients with severe community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio >30 with intracerebral pyruvate level <70 µmol L−1. Non-ischemic mitochondrial dysfunction was defined as LP-ratio >30 at a normal or increased interstitial concentration of pyruvate (≥70 μmol L−1). Patients with LP-ratios <30 were classified as no mitochondrial dysfunction.

Results

The biochemical pattern was in 8 patients (10 microdialysis catheters) classified as no mitochondrial dysfunction, in 5 patients classified as non-ischemic mitochondrial dysfunction, and in 2 patients (3 catheters) classified as ischemia.

Conclusions

In patients with severe community-acquired meningitis, compromised cerebral energy metabolism occurs frequently and was diagnosed in 7 out of 15 cases. A biochemical pattern of non-ischemic mitochondrial dysfunction appears to be a more common underlying condition than cerebral ischemia.
Literature
1.
Van de Beek D, de Gans J, Tunkel AR, Wijdicks EFM. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354:44–53.CrossRefPubMed
2.
Lindvall P, Ahlm C, Ericsson M, Gothefors L, Naredi S, Koskinen LO. Reducing intracranial pressure may increase survival among patients with bacterial meningitis. Clin Infect Dis. 2004;38:384–90.CrossRefPubMed
3.
Aronin S, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med. 1998;129:862–9.CrossRefPubMed
4.
Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. a review of 493 episodes. N Engl J Med. 1993;328:21–8.CrossRefPubMed
5.
Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–59.CrossRefPubMed
6.
Flores-Cordero JM, Amaya-Villar R, Rincón-Ferrari MD, et al. Acute community-acquired meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Int Care Med. 2003;29:1967–73.CrossRef
7.
Zimmerli W. Acute bacterial meningitis: time for a better outcome. Int Care Med. 2003;29:1868–70.CrossRef
8.
Baussart B, Cheisson G, Compain M, et al. Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure. Acta Anaesthesiol Scand. 2006;50:762–5.CrossRefPubMed
9.
Edberg M, Furebring M, Sjölin J, Enblad P. Neurointensive care of patients with severe community-acquired meningitis. Acta Anaesthesiol Scand. 2011;55:732–9.CrossRefPubMed
10.
Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults. Spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003;126:1015–25.CrossRefPubMed
11.
Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. A risk score for unfavourable outcome in adults with bacterial meningitits. Ann Neurol. 2008;63:90–7.CrossRefPubMed
12.
Katchanov J, Heuschmann PU, Endres M, Weber JR. Cerebral infarction in bacterial meningitis: predictive factors and outcome. J Neurol. 2010;257:716–20.CrossRefPubMed
13.
Vergouwen MDI, Schut ES, Troost D, van de Beek D. Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Neurocrit Care. 2010;13:217–27.CrossRefPubMed
14.
Shut ES, Lucas MJ, Brouwer MC, Vergouwen MDI, van der Ende A, van de Beek D. Cerebral infarction in adults with bacterial meningitis. Neurocrit Care. 2012;16:421–7.CrossRef
15.
Tavakoli H, Mela L. Alterations of mitochondrial metabolism and protein concentrations in subacute septicemia. Infect Immun. 1982;38:536–41.PubMedCentralPubMed
16.
Brealey D, Brand M, Hargreavens I, et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002;360:219–23.CrossRefPubMed
17.
Barichello T, Savi GD, Simöes LR, et al. Evaluation of mitochondrial respiratory chain in the brain of rats after pneumococcal meningitis. Brain Res Bull. 2010;82:302–7.CrossRefPubMed
18.
Barichello T, Generoso JS, Collodel A, Moreira AP, de Almeida SM. Patophysiology of acute meningitis caused by Streptococcus pneumoniae and and junctive therapy approaches. Arq Neuropsiquiatr. 2012;70:366–72.PubMed
19.
Jeger W, Djafarzadeh S, Jakob SM, Takala J. Mitochondrial function in sepsis. Eur J Clin Invest. 2013;43:532–42.CrossRefPubMed
20.
Reinstrup P, Stahl N, Mellergard P, et al. Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery. 2000;47:701–9.PubMed
21.
Amer-Wahlin I, Nord A, Bottalico B, et al. Fetal cerebral energy metabolism and electrocardiogram during experimental umbilical cord occlusion and resuscitation. J Matern Fetal Neonatal Med. 2010;23:158–66.CrossRefPubMed
22.
Ståhl N, Mellergård P, Hallström Å, Ungerstedt U, Nordström CH. Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand. 2001;45:977–85.CrossRefPubMed
23.
Nielsen TH, Bindslev TT, Pedersen SM, Toft P, Olsen NV, Nordstrom CH. Cerebral energy metabolism during induced mitochondrial dysfunction. Acta Anaesthesiol Scand. 2013;57:229–35.CrossRefPubMed
24.
Nielsen TH, Olsen NV, Toft P, Nordström CH. Cerebral energy metabolism during mitochondrial dysfunction induced by cyanide in piglets. Acta Anaesthesiol Scand. 2013;57:793–801.CrossRefPubMed
25.
Nielsen TH, Schalén W, Ståhl N, Toft P, Reinstrup P, Nordström CH. Bedside diagnosis of mitochondrial dysfunction after malignant middle cerebral artery infarction. Neurocrit Care. 2013. doi:10.​1007/​s12028-013-9875-5.
26.
Jacobssen A, Nielssen TH, Nilsson O, Schalén W, Nordström CH. Bedside diagnosis of mitochondrial dysfunction in subarachnoid hemorrhage. Acta Neurol Scand. 2014. doi:10.​1111/​ane.​12258.
27.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;7872:81–4.CrossRef
28.
Asgeirsson B, Grände PO, Nordström CH. A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med. 1994;20:260–7.CrossRefPubMed
29.
Grände PO, Asgeirsson B, Nordström CH. Volume targeted therapy of increased intracranial pressure: the Lund concept unifies surgical and non-surgical treatments. Acta Anaesthesiol Scand. 2002;46:929–41.CrossRefPubMed
30.
Siesjö BK. Brain energy metabolism. Chichester: Wiley; 1978.
31.
Nordström CH, Rehncrona S, Siesjö BK. Restitution of cerebral energy state, as well as of glycolytic metabolites, citric acid cycle intermediates and associated amino acids after 30 minutes of complete ischemia in rats anaesthetized with nitrous oxide or phenobarbital. J Neurochem. 1978;30:479–86.CrossRefPubMed
32.
Nordström CH, Rehncrona S, Siesjö BK. Effects of phenobarbital in cerebral ischemia. Part II: restitution of cerebral energy state, as well as of glycolytic metabolites, citric acid cycle intermediates and associated amino acids after pronounced incomplete ischemia. Stroke. 1978;9:335–43.CrossRefPubMed
33.
Pierre K, Pellerin L. Monocarboxylate transporters in the central nervous system: distribution, regulation and function. J Neurochem. 2005;94:1–14.CrossRefPubMed
34.
Anderson CM, Sanson RA. Astrocyte glutamate transport: review of properties, regulation and physiological function. Glia. 2000;32:1–14.CrossRefPubMed
35.
Nedergaard M, Takano T, Hansen AJ. Beyond the role of glutamate as a neurotransmitter. Nat Rev Neurosci. 2002;3:748–55.CrossRefPubMed
36.
Samuelsson C, Hillered L, Zetterling M, et al. Cerebral glutamine and glutamate levels in relation to compromised energy metabolism: a microdialysis study in subarachnoid hemorrhage patients. J Cereb Blood Flow Metab. 2007;27:1309–17.CrossRefPubMed
37.
Ungerstedt U, Bäckström T, Hallström Å, Grände PO, Mellergård P, Nordström CH. Microdialysis in normal and injured human brain. In: Kinney JM, Tucker HN, editors. Physiology, stress, and malnutrition: functional correlates. Philadelphia NY: Nutritional Intervention. Lippincott-Raven Publishers; 1997. p. 361–74.
38.
Hillered L, Valtysson J, Enblad P, Persson L. Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry. 1998;64:486–91.CrossRefPubMedCentralPubMed
39.
Vespa PM, O’Phelan K, McArthur D, et al. Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion. Crit Care Med. 2007;35:1153–60.CrossRefPubMed
Metadata
Title
Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis
Authors
Frantz R. Poulsen
Mette Schulz
Anne Jacobsen
Åse B. Andersen
Lykke Larsen
Wilhelm Schalén
Troels H. Nielsen
Carl-Henrik Nordström
Publication date
01-04-2015
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2015
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-014-0057-x

Other articles of this Issue 2/2015

Neurocritical Care 2/2015 Go to the issue

Original Article

Therapeutic Intravascular Normothermia Reduces The Burden of Metabolic Crisis

Original Article

Rapid Unexpected Brain Herniation in Association with Renal Replacement Therapy in Acute Brain Injury: Caution in the Neurocritical Care Unit

Original Article

Non-convulsive Status Epilepticus and Non-convulsive Seizures in Neurological ICU Patients

Translational Research

Modeling the Pattern of Contrast Extravasation in Acute Intracerebral Hemorrhage Using Dynamic Contrast-Enhanced MR

Original Article

Kidney-Brain Link in Traumatic Brain Injury Patients? A preliminary report

Practical Pearl

A Cause of Atypical Intracranial Subarachnoid Hemorrhage: Posterior Spinal Artery Aneurysms