Novel approach to comprehensive diagnosis of intracranial hypertension in children with neuroinfections

Abstract

Objective. To develop an algorithm of structural and functional non-invasive diagnosis of different stages of intracranial hypertension (ICH) in children with acute meningitis and encephalitis. Patients and methods. We examined 115 patients aged 1 month to 17 years. We used neurosonography (NSG), transcranial duplex scanning (TCD), ultrasound examination of the optic nerve (ON), and fundus examination by an ophthalmologist. We have developed a comprehensive structural and functional diagnostic algorithm for different ICH stages in children with suspected neuroinfections. This algorithm should be applied within a day upon admission to the intensive care unit and includes NSG, TCD, ON ultrasound, and fundus examination by an ophthalmologist. The exact diagnostic criteria were developed for each method. NSG: clear contours of the brain stem; lateral ventricles between 12 and 16 mm in size; bone-brain diastasis between 1 and 4 mm. TCD: systolic flow rate in the middle cerebral artery between 60 and 180 cm/s; systolic flow rate in the veins of Rosenthal between 10 and 20 cm/s; arterial resistance index up to 0.8; venous resistance index up to 0.5. ON ultrasound: ON thickness up to 5.5 mm in children aged 1 month to 5 years and up to 5.8 mm in children aged 5–17 years. Fundus examination: dilated veins in the fundus. Decompensated ICH: deformed brain stem pattern; lateral ventricles up to 11 mm, bone-brain diastasis <1 mm; systolic flow rate in the middle cerebral artery up to 60 mm/s; systolic flow rate in the veins of Rosenthal up to 10 mm/s; reverberation pattern; ON thickness 6.5 ± 0.43 mm with unclear ON contours; stagnant disk of the optic nerve. We provide clinical examples that illustrate the effectiveness of the new algorithm, as well as the effectiveness of comprehensive therapy with cytoflavin during acute disease. Cytoflavin has multiple effects on the organism, improves cerebral hemodynamics and metabolism. Key words: intracranial hypertension, children, duplex, optic nerve, meningitis, neurosonography, ultrasound, encephalitis, cytoflavin