Cerebral vasospasm in shunt infection
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Cerebral vasospasm in shunt infection Martin H. Deininger Æ Ansgar Berlis Æ Juergen Buttler
Published online: 13 April 2007 Ó Humana Press Inc. 2007
Abstract Objective In bacterial shunt infection, CNS inflammation is a frequently observed complication that may cause vascular complications including vasospasms. Here, we describe the first patient with shunt infection-induced cerebral vasospasms. Methods A 35 year old woman with a ventriculoperitoneal shunt that was implanted years before developed facial nerve palsy and somnolence one week before admission to the hospital. Results After admission, the shunt was removed, and an external ventricular drainage was inserted. Microbiological analyses revealed coagulase-negative Staphylococcus on abdominal and cranial catheters. Follow-up NMR showed infarctions. Transcranial doppler sonography and cerebral arteriography revealed severe generalized cerebral vasospasms. Inspite of triple-H therapy and intraarterial spasmolysis, bilateral anterior and media artery infarction evolved. The patient was dismissed in a vegetative state. Conclusions This case shows that severe cerebral vasospasms are a serious complication in patients with bacterial shunt infection that should be considered in patients, that don’t improve following adequate antibiotic treatment.
M. H. Deininger (&) J. Buttler Department of General Neurosurgery, University of Freiburg Medical School, Breisacher Str. 64, Freiburg 79106, Germany e-mail: [email protected] A. Berlis Department of Neuroradiology, University of Freiburg Medical School, Freiburg, Germany
Keywords
Infarction Meningitis Shunt Vasospasm
Introduction Infection remains a serious complication in shunt patients. Mortality rates have remained unaltered despite the development of powerful antibiotic treatment strategies. Two different types of infection can be differentiated: early and delayed. Early shunt infection rates range from 0.3–15% [1, 2], with a mortality rate ranging from 1.5–22% [3, 4]. Many factors are associated with shunt infection, including the age of the patient, the etiology of hydrocephalus, and the type of shunt implanted [1–5]. Delayed shunt infections are thought to be independent of the initial shunt surgery. About 12% of all shunt infections are delayed, following other inflammatory conditions like appendicitis, or iatrogenic perforation [6]. In shunt infection, bacterial CNS infection is a common complication. The reasons for the occasional grim outcome of bacterial CNS infection are unknown, however, cerebral vasospasms are a documented, but rarely observed phenomenon [7–10]. In a prospective study of adults with bacterial meningitis, alterations of the cerebral vessel systems were observed in 13 of 27 patients with focal deficits and no improvement after three days of antibiotic therapy [11]. Those who survive risk intellectual, cognitive, and neurological deficits [12]. We now demonstrate the case of a patient with coagulase-negative Staphylococcus delayed ventriculoperitone
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