{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:07:47Z","timestamp":1771250867740,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health through \u2018Ricerca Corrente Linea 3\u2019"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Meningoencephalitis is a complex inflammatory condition of the CNS that can result in significant morbidity and mortality in critically ill adults. Accurate and timely neuromonitoring is essential for guiding management and improving outcomes. This study aimed to descriptively evaluate the prognostic value of early TCCD monitoring, particularly the pulsatility index, and its integration with conventional and perfusion MRI in patients with meningoencephalitis. Methods: We present an observational, retrospective, cohort study involving ten adult patients (median age 56 years, IQR 45.5\u201368.5; mean 55.9, range 35\u201376) with neurological syndromes caused by suspected or confirmed infectious meningoencephalitis. Etiologies included bacterial meningitis\/meningoencephalitis (50%), viral meningoencephalitis (10%), neurotoxoplasmosis (10%), progressive multifocal leukoencephalopathy (10%), and undetermined origin (20%). Patients underwent TCCD and MRI within 24 h. In five cases, standard MRI sequences were acquired, while in the remaining five, perfusion imaging was performed using Arterial Spin Labelling (ASL). A favorable outcome was defined as survival with neurological recovery (Glasgow Outcome Scale &gt; 5) at ICU discharge. Results: TCCD-derived PI provided valuable information on cerebral hemodynamics. PI values \u2264 1.25 were associated with favorable clinical outcomes and symmetrical MRI findings. Conversely, PI &gt; 1.25 correlated with poor prognosis and often preceded MRI-detectable structural damage. When combined with ASL, PI mirrored the detected perfusion asymmetries and was associated with poor prognosis in fatal cases. Conclusions: Bedside TCCD can offer real-time assessment of cerebrovascular dynamics and, when integrated with conventional and ASL MRI, could enhance the understanding of pathophysiological processes in meningoencephalitis, supporting timely and informed decisions in neurocritical care.<\/jats:p>","DOI":"10.3390\/clinpract16020041","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:37:28Z","timestamp":1771245448000},"page":"41","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcranial Doppler Pulsatility Index and MRI Findings in Meningoencephalitis: A Pilot Observational Retrospective Cohort Study in Critically Ill Patients"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6100-8442","authenticated-orcid":false,"given":"Maria Grazia","family":"Bocci","sequence":"first","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0304-6712","authenticated-orcid":false,"given":"Giulia","family":"Capecchi","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3099-0900","authenticated-orcid":false,"given":"Antonio","family":"Lesci","sequence":"additional","affiliation":[{"name":"Istituto di Anestesiologia e Rianimazione, Universit\u00e0 Cattolica del Sacro Cuore, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3928-7962","authenticated-orcid":false,"given":"Dorotea","family":"Rubino","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Caravella","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Taloni","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerio","family":"Sabatini","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6089-1074","authenticated-orcid":false,"given":"Candido","family":"Porcelli","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia Valeria","family":"Stazi","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Garotto","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Mattiucci","sequence":"additional","affiliation":[{"name":"Clinical and Research Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5606-8712","authenticated-orcid":false,"given":"Emanuele","family":"Nicastri","sequence":"additional","affiliation":[{"name":"Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Ascoli Bartoli","sequence":"additional","affiliation":[{"name":"Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Maffongelli","sequence":"additional","affiliation":[{"name":"Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiliano","family":"Cingolani","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5115-709X","authenticated-orcid":false,"given":"Fabrizio","family":"Albarello","sequence":"additional","affiliation":[{"name":"Radiology Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4635-5549","authenticated-orcid":false,"given":"Giulia","family":"Anello","sequence":"additional","affiliation":[{"name":"Radiology Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7275-7358","authenticated-orcid":false,"given":"Paolo","family":"Campioni","sequence":"additional","affiliation":[{"name":"Radiology Unit, National Institute for Infectious Diseases \u201cLazzaro 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thrombophlebitis","volume":"96","author":"Derber","year":"2012","journal-title":"Med. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ncl.2021.08.006","article-title":"Infectious Meningitis and Encephalitis","volume":"40","author":"Bystritsky","year":"2022","journal-title":"Neurol. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S282","DOI":"10.1007\/s12028-014-0077-6","article-title":"The International Multidisciplinary Consensus Conference on Multimodality Mon-itoring in Neurocritical Care: A list of recommendations and additional conclusions: A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine","volume":"21","author":"Menon","year":"2014","journal-title":"Neurocrit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40477-018-0282-9","article-title":"Transcranial Doppler ultrasound in neurocritical care","volume":"21","author":"Blanco","year":"2018","journal-title":"J. Ultrasound"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s00134-019-05610-4","article-title":"Brain ultrasonography: Methodology, basic and advanced principles and clinical applications. A narrative review","volume":"45","author":"Robba","year":"2019","journal-title":"Intensiv. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/jmri.28117","article-title":"Contrast-Enhanced Fluid-Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances","volume":"56","author":"Ahn","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/S1474-4422(12)70203-X","article-title":"MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): A prospective cohort study","volume":"11","author":"Lansberg","year":"2012","journal-title":"Lancet Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s00234-005-1383-7","article-title":"Contrast-enhanced FLAIR in the early diagnosis of infectious meningitis","volume":"47","author":"Splendiani","year":"2005","journal-title":"Neuroradiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1148\/radiol.2016150789","article-title":"Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications","volume":"281","author":"Haller","year":"2016","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.diii.2013.06.010","article-title":"Arterial spin labeling (ASL) perfusion: Techniques and clinical use","volume":"94","author":"Bannier","year":"2013","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s44158-022-00082-3","article-title":"POCUS, how can we include the brain? An overview","volume":"2","author":"Caldas","year":"2022","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1007\/s12028-019-00766-9","article-title":"Brain Ultrasonography Consensus on Skill Recommendations and Competence Levels Within the Critical Care Setting","volume":"32","author":"Robba","year":"2020","journal-title":"Neurocrit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5114\/ait.2024.146640","article-title":"Transcranial sonography: Practical use in the intensive care unit","volume":"56","author":"Baska","year":"2024","journal-title":"Anaesthesiol. Intensiv. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.surneu.2003.12.007","article-title":"Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP)","volume":"62","author":"Bellner","year":"2004","journal-title":"Surg. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s13054-022-03978-2","article-title":"Transcranial Doppler as a screening test to exclude intracranial hypertension in brain-injured patients: The IMPRESSIT-2 prospective multicenter international study","volume":"26","author":"Rasulo","year":"2022","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13054-017-1632-2","article-title":"The accuracy of transcranial Doppler in excluding intracranial hypertension following acute brain injury: A multicenter prospective pilot study","volume":"21","author":"Rasulo","year":"2017","journal-title":"Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"802","DOI":"10.3171\/jns.1998.88.5.0802","article-title":"Cerebral perfusion pressure in head-injured patients: A noninvasive assessment using transcranial Doppler ultrasonography","volume":"88","author":"Czosnyka","year":"1998","journal-title":"J. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Robba, C., Cardim, D., Tajsic, T., Pietersen, J., Bulman, M., Donnelly, J., Lavinio, A., Gupta, A., Menon, D.K., and Hutchinson, P.J.A. (2017). Ultrasound non-invasive measurement of intracranial pressure in neurointensive care: A prospective observational study. PLoS Med., 14.","DOI":"10.1371\/journal.pmed.1002356"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s12028-012-9672-6","article-title":"Transcranial Doppler pulsatility index: What it is and what it isn\u2019t","volume":"17","author":"Budohoski","year":"2012","journal-title":"Neurocrit. Care"},{"key":"ref_20","first-page":"44","article-title":"Intracranial Pressure\u2013Derived Cerebrovascular Reactivity Indices, Chronological Age, and Biological Sex in Traumatic Brain Injury: A Scoping Review","volume":"3","author":"Batson","year":"2022","journal-title":"Neurotrauma Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1161\/STROKEAHA.110.594168","article-title":"Cerebral autoregulation in stroke: A review of transcranial Doppler studies","volume":"41","author":"Aries","year":"2010","journal-title":"Stroke"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S95","DOI":"10.1007\/s12028-014-0046-0","article-title":"Participants in the International Multidisciplinary Consensus Conference on Multimodality Moni-toring. Monitoring of cerebral autoregulation","volume":"21","author":"Czosnyka","year":"2014","journal-title":"Neurocrit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Takanashi, J.-I., and Uetani, H. (2023). Neuroimaging in acute infection-triggered encephalopathy syndromes. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1235364"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"386","DOI":"10.2463\/mrms.mp.2015-0140","article-title":"Arterial Spin-labeling in Central Nervous System Infection","volume":"15","author":"Noguchi","year":"2016","journal-title":"Magn. Reson. Med Sci."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/2\/41\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:11:01Z","timestamp":1771247461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/2\/41"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["clinpract16020041"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16020041","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]}}}