Комплексный структурно-функциональный подход к неинвазивной диагностике внутричерепной гипертензии и ее степени при менингите и энцефалите у детей

Abstract

Intracranial hypertension is a factor complicating the course of neuroinfections and determining its outcomes. The original article describes the results of the examination of 115 patients with meningitis and encephalitis. The purpose — to develop a comprehensive structural and functional approach to noninvasive diagnosis of intracranial hypertension (ICH) and its degree in meningitis and encephalitis. Methods: neurosonography (NSG); transcranial duplex scanning (TCDS); optic nerve sheath diameter (ONSD); ocular fundus. Results. A technique of ICH diagnostics is proposed. All patients suspected for neuroinfection with the clinical manifestations of general infection and meningeal syndrome during the first day at hospital, without preliminary preparation, undergo NSG, optic nerve sheath diameter estimation, TCDS, and ocular fundus exammination. The characteristic features for ICH in the stage of compensation are: clear contours of the brain stem, lateral ventricles from 12 to 16 mm, bone-marrow diastasis from 1 mm to 4 mm; systolic blood flow velocity in the middle cerebral artery from 60 cm/s to 180 cm/s, the Rosenthal’s veins — from 10 cm/s to 20 cm/s, an increase in the resistance index in the arteries up to 0.8, in the veins up to 0.5; ONSD: in children aged 1 month 5 years up to 5.5 mm, in children aged 5 to 17 years up to 5.8 mm; expansion of the veins in the fundus. The characteristic features for ICH in the stage of decompensation are: the deformation of the brain stem, lateral ventricles up to 11 mm, bone-marrow diastasis size less than 1 mm; systolic blood flow velocity in the middle cerebral artery up 60 cm/s, the Rosenthal’s veins up to 10 cm/s, detection of a reverberation pattern; ONSD: 6.5 ± 0.43 mm with a loss of clarity of the contours; stagnation of ON disk in the fundus.