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Case Reports: Reminder of important clinical lesson
Transtentorial herniation syndrome from meningococcal meningitis in a young woman: the case for neurocritical care
  1. Eleen Yang1,
  2. Mypinder Sekhon2 and
  3. Donald Griesdale1
  1. 1Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  2. 2Department of Medicine, Division of Critical Care Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Donald Griesdale; donald.griesdale{at}ubc.ca

Abstract

We report a case of a previously healthy early adolescent female who presented with meningococcal meningitis. While in hospital, she had marked neurologic deterioration with clinical herniation from malignant cerebral oedema. She was transferred to a neurocritical care centre where she underwent invasive intracranial pressure (ICP) and brain tissue oxygen (PbtO2) monitoring. Early in her course, she demonstrated a compete absence of autoregulation, with pressure passive cerebral blood flow. As a result, maintaining a mean arterial pressure between 50 mm Hg and 60 mm Hg, which ensured adequate cerebral oxygenation, while avoiding increases in ICP. Although her course was initially complicated by bilateral optic neuropathy, she has subsequently made a full neurologic recovery and is now undertaking postsecondary education. This case highlights that access to specialist neurocritical care, guided by neurophysiologic monitoring of ICP and PbtO2, may help improve outcomes, even among those patients with catastrophic cerebral oedema from bacterial meningitis.

  • Meningitis
  • Adult intensive care

http://dx.doi.org/10.1136/bcr-2022-253191

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    Footnotes

    • Twitter @dgriesdale

    • Contributors Planning and conception of the manuscript (EY, MS, DG). Acquisition of data (EY, MS, DG). Drafting and critical revision of manuscript (EY, MS, DG). Final approval of the manuscript (EY, MS, DG). Accountable for all aspects of the work in ensuring accuracy and integrity (EY, MS, DG).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests MS is supported by the Vancouver Coastal Health Research Institute Clinician Scientist Award, and the Michael Smith Foundation for Health Research Health-Professional Investigator Award. DG is funded by the Michael Smith Foundation for Health Research Health-Professional Investigator Award.

    • Provenance and peer review Not commissioned; externally peer reviewed.