Treatment of intracranial hypertension and aspects on lumbar dural puncture in severe bacterial meningitis

Background: Brain stem herniation due to raised intracranial pressure (ICP) is a common cause of mortality in severe bacterial meningitis, but continuous measurements of ICP and the effects of ICP-reducing therapy in these patients have, to our knowl-edge, not been described. Methods: During a four-year period, an ICP-monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20mmHg was treated using the Lund Concept, which includes antihypertensive therapy (b1-antagonist,a2-agonist), normalization of the plasma colloid osmotic pressure and the blood volume, and antistress therapy. Results: ICP above 20mmHg was found in all 12 patients studied. It was effectively reduced in all but two patients, who died. Both patients had a low cerebral perfusion pressure (,1