A clinical study of vasculopathy of central nervous system infections in critically ill children / 中华实用儿科临床杂志

ABSTRACT

Objective:To explore the vasculopathy of central nervous system (CNS) infections in critically ill children.Methods:The clinical data of 43 children with CNS infections requiring mechanical ventilation admitted to the Intensive Care Unit of Beijing Children′s Hospital from July 2017 to October 2018 were analyzed retrospectively.The peak systolic velocity and the pulsatility index of the bilateral middle cerebral artery in each child were detected by Transcranial Doppler (TCD), and the vasculopathy was explored by combining with the imaging manifestations such as computed tomography or magnetic resonance imaging.Results:TCD results were normal in 11 cases and abnormal in 32 cases.In the abnormal group, the cerebral blood flow velocity increased in 27 cases and decreased in 5 cases.Of the 27 cases with increased velocity, 15 cases met the criteria of vasospasm, and 4 of the 5 cases with decreased velocity showed shock waves.Among all patients, 21 cases (48.9%) had cerebral hypoxic-ischemic manifestations, 6 cases (13.9%) had cerebral hemorrhage (5 cases were accompanied with cerebral ischemia), and 2 cases (4.7%) were complicated with cerebral malacia during hospitalization.Twenty cases in all of them had completed magnetic resonance angiography, which was abnormal in 14 cases (70%). There were 32 cases (74.4%) with poor prognosis at discharge, including 10 cases of death or brain death (23.3%, 10/32 cases).Conclusions:Cerebral hemodynamic abnormalities and ischemic changes are more common in children with severe encephalitis.Patients with vasospasm or decreased flow velocity have the worst prognosis.