{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:22:20Z","timestamp":1784697740712,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2002,4,19]],"date-time":"2002-04-19T00:00:00Z","timestamp":1019174400000},"content-version":"vor","delay-in-days":49,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2002,3]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> 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\u2010reducing therapy in these patients have, to our knowledge, not been described.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> During a four\u2010year period, an ICP\u2010monitoring device was implanted in patients admitted to our hospital with severe bacterial meningitis and suspected intracranial hypertension. ICP above 20\u2003mmHg was treated using the Lund Concept, which includes antihypertensive therapy (\u03b2<jats:sub>1<\/jats:sub>\u2010antagonist,\u03b1<jats:sub>2<\/jats:sub>\u2010agonist), normalization of the plasma colloid osmotic pressure and the blood volume, and antistress therapy.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> ICP above 20\u2003mmHg 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 (&lt;10\u2003mmHg), dilated pupils at start of therapy and were beyond recovery. Radiological signs of brain swelling were present in only five patients. Seven patients recovered fully, while mild audiological impairment was observed in two and minor neurological sequelae in one patient. Eight patients showed signs suggesting imminent brain stem herniation before start of ICP\u2010reducing treatment, seven of whom had been subjected to diagnostic lumbar dural puncture shortly before development of the brain stem symptoms. These symptoms gradually regressed after initiation of therapy, and in one patient reversal of brain stem herniation was documented by MRI.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Severe bacterial meningitis can be associated with increased ICP, which can be reduced using the Lund Concept. The high survival rate, the low frequency of sequelae and the reversal of signs of imminent brain stem herniation in these high\u2010risk patients indicated beneficial effects of the intervention. The study confirms earlier observations that lumbar dural puncture is potentially hazardous in patients with intracranial hypertension, because it may trigger brain stem herniation. 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