Research

Case report: Greater meningeal inflammation in lumbar than in ventricular region in human bacterial meningitis

Walid Naija¹, Joaquim Matéo², Laurent Raskine³, Jean-François Timsit⁴, Anne-Claire Lukascewicz⁵, Bernard George⁶, Didier Payen⁷ and Alexandre Mebazaa⁸

¹Fellow, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France

²Attending, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France

³Attending, Department of Microbiology, Lariboisière University Hospital, Paris, France

⁴Professor, Medical ICU, Bichat University, Paris, France

⁵Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France

⁶Professor and Chairman, Department of Neurosurgery, Lariboisière University Hospital, Paris, France

⁷Professor and Chairman, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France

⁸Professor, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Paris, France

author email corresponding author email

Critical Care 2004, 8:R491-R494doi:10.1186/cc2972

Published:	27 October 2004

Abstract

Differences in the composition of ventricular and lumbar cerebrospinal fluid (CSF) based on single pairs of samples have previously been described. We describe a patient that developed post-surgical recurrent meningitis monitored by daily biochemical and bacteriological CSF analysis, simultaneously withdrawn from lumbar space and ventricles. A 20-year-old Caucasian man was admitted to the ICU after a resection of a chordoma that extended from the sphenoidal sinus to the anterior face of C2. CSF was continuously leaking into the pharyngeal cavity after surgery, and three episodes of recurrent meningitis, all due to Pseudomonas aeruginosa O12, occurred. Our case showed permanent ventricular-to-lumbar CSF gradients of leukocytes, protein and glucose that were increased during the acute phase of meningitis, with the greatest amplitude being observed when bacteria were present in both ventricular and lumbar CSF. This might suggest a greater extent of meningeal inflammation in the lumbar than in the ventricular region. Our case also showed that the increase in intravenous antibiotics (cefepim from 8 to 12 g/day and ciprofloxacine from 1.2 to 2.4 g/day) led to an increase in concentration in plasma but not in CSF.