{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:07:06Z","timestamp":1781244426905,"version":"3.54.1"},"reference-count":10,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,21]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>We report a case of a previously healthy early adolescent female who presented with meningococcal meningitis. While in hospital, she had marked neurologic deterioration with clinical herniation from malignant cerebral oedema. She was transferred to a neurocritical care centre where she underwent invasive intracranial pressure (ICP) and brain tissue oxygen (P<jats:sub>bt<\/jats:sub>O<jats:sub>2<\/jats:sub>) monitoring. Early in her course, she demonstrated a compete absence of autoregulation, with pressure passive cerebral blood flow. As a result, maintaining a mean arterial pressure between 50 mm Hg and 60\u2009mm Hg, which ensured adequate cerebral oxygenation, while avoiding increases in ICP. Although her course was initially complicated by bilateral optic neuropathy, she has subsequently made a full neurologic recovery and is now undertaking postsecondary education. This case highlights that access to specialist neurocritical care, guided by neurophysiologic monitoring of ICP and P<jats:sub>bt<\/jats:sub>O<jats:sub>2<\/jats:sub>, may help improve outcomes, even among those patients with catastrophic cerebral oedema from bacterial meningitis.<\/jats:p>","DOI":"10.1136\/bcr-2022-253191","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T10:26:15Z","timestamp":1669803975000},"page":"e253191","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Transtentorial herniation syndrome from meningococcal meningitis in a young woman: the case for neurocritical care"],"prefix":"10.1136","volume":"15","author":[{"given":"Eleen","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mypinder","family":"Sekhon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Critical Care Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5985-8624","authenticated-orcid":false,"given":"Donald","family":"Griesdale","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"2025082702203129000_15.11.e253191.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005384"},{"key":"2025082702203129000_15.11.e253191.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301073280104"},{"key":"2025082702203129000_15.11.e253191.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-015-1531-z"},{"key":"2025082702203129000_15.11.e253191.4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1021\/acsinfecdis.9b00319","article-title":"Investigating bacterial penetration of the Blood\u2013Brain barrier for the pathogenesis, prevention, and therapy of bacterial meningitis","volume":"6","author":"Kim","year":"2020","journal-title":"ACS Infect. Dis."},{"key":"2025082702203129000_15.11.e253191.5","doi-asserted-by":"crossref","DOI":"10.3171\/2017.8.FOCUS17419","article-title":"The role of ICP monitoring in meningitis","volume":"43","author":"Tariq","year":"2017","journal-title":"Neurosurg Focus"},{"key":"2025082702203129000_15.11.e253191.6","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.485706"},{"key":"2025082702203129000_15.11.e253191.7","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182514eb6"},{"key":"2025082702203129000_15.11.e253191.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0091976","article-title":"Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study","volume":"9","author":"Glim\u00e5ker","year":"2014","journal-title":"PLoS One"},{"key":"2025082702203129000_15.11.e253191.9","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1017\/cjn.2017.25","article-title":"Implementation of neurocritical care is associated with improved outcomes in traumatic brain injury","volume":"44","author":"Sekhon","year":"2017","journal-title":"Can J Neurol Sci"},{"key":"2025082702203129000_15.11.e253191.10","doi-asserted-by":"publisher","DOI":"10.1172\/JCI114475"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-253191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:20:38Z","timestamp":1756286438000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-253191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":10,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,30]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/bcr-2022-253191"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-253191","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}