BMJ  2008;336:1453 (28 June), doi:10.1136/bmj.39619.510405.3A

Letters

Invasive meningococcal disease

Cerebral perfusion in invasive meningococcal disease

The first 150 words of the full text of this article appear below.

I am surprised that the SIGN guidelines (and therefore this summary of them1) make no mention of the importance of adequate cerebral perfusion in those with invasive meningococcal disease. Cerebral perfusion pressure is the difference between the mean arterial pressure (which is usually low from the associated hypotensive shock) and the intracranial pressure (which is often high as a result of meningeal inflammation and cerebral oedema).

Consequently, cerebral perfusion pressure takes a "double whammy," and the end result may be clinically significant cerebral ischaemia from profoundly inadequate cerebral perfusion, which is likely to worsen neurological outcomes.

The SIGN guidelines discuss the importance of early inotropic support, but fail to address the issues of raised intracranial pressure and the reduction in cerebral perfusion. If there are clinical or computed tomography scan signs of raised intracranial pressure, the use of osmotic agents such as mannitol should be actively considered and if . . . [Full text of this article]

Peter J Flegg, consultant physician

1 Blackpool Victoria Hospital, Blackpool FY3 8NR

dr.flegg@bfwh.nhs.uk


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Management of invasive meningococcal disease in children and young people: summary of SIGN guidelines
U Theilen, L Wilson, G Wilson, J O Beattie, S Qureshi, D Simpson on behalf of the Guideline Development Group
BMJ 2008 336: 1367-1370. [Extract] [Full Text] [PDF]

Access jobs at BMJ Careers
Whats new online at Student BMJ