Letters to the Editor
3. 4. 5.
and the forehead, associated with a frontal bone defect. Surg Neurol 1984;22:503‑8. Sari A, Dinc H, Gumele HR. Case report. Interhemispheric lipoma associated with subcutaneous lipoma. Eur Radiol 1998;8:628‑30. Mitilian D, Haddad D, Lenoir M, Boudjemaa S, Vazquez MP, Picard A. Interhemispheric lipoma associated with frontal subcutaneous lipoma. J Plast Reconstr Aesthet Surg 2009;62:e427‑9. Saatci I, Aslan C, Renda Y, Besim A. Parietal lipoma associated with cortical dysplasia and abnormal vasculature: Case report and review of the literature. AJNR Am J Neuroradiol 2000;21:1718‑21.
model. Addition of vasoconstrictive agents like triptans in the midst of this thrombogenic environment has the potential of critically reducing cerebral blood flow and, thus, needs careful thought and risk stratification before use. Deb Kumar Mojumder Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
Access this article online Quick Response Code:
Address for correspondence: Dr. Deb Kumar Mojumder, Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, 3601 4th Street, Lubbock, TX, USA. E‑mail: [email protected]
Website: www.ruralneuropractice.com
DOI: 10.4103/0976-3147.127932
References
Careful consideration for use of triptans for the control of headache in bacterial meningitis Sir, I read with great interest the article entitled “Nitrite, vasodilation, and headache in bacterial meningitis: Theoretical approach” by Viroj Wiwanitkit. [1] The author proposes a reasonable hypothesis based on literature review that vasodilatation secondary to nitrite production by bacteria can result in vasodilatation in the blood vessels and stimulation of nociceptive nerve endings in the meningeal vessel wall. As the author points out, in a rat model of pneumococcal meningitis, it was also found that zolmitriptan and naratriptan reduced the influx of leukocytes into the cerebrospinal fluid, reduced intracranial pressure, reduced brain water content, and attenuated the increase of regional cerebral blood flow.[2] Despite these benefits of the use of triptans in the animal model of meningitis, its use in patients as a cerebral vasoconstrictor needs careful thought. Pneumococcus has known thrombogenic potential via activation of the extrinsic coagulation pathway. [3‑6] Ischemic strokes have been reported in patients with pneumococcal meningitis in the past.[7,8] Steroid, used for the management of bacterial meningitis, also has a potential for activation of the extrinsic coagulation pathway,[9,10] a fact that was not tested in the rat animal
1. Wiwanitkit V. Nitrite, vasodilation, and headache in bacterial meningitis: Theoretical approach. J Neurosci Rural Pract 2013;4:374‑5. 2. Hoffmann O, Keilwerth N, Bille MB, Reuter U, Angstwurm K, Schumann RR, et al. Triptans reduce the inflammatory response in bacterial meningitis. J Cereb Blood Flow Metab 2002;22:988‑96. 3. Giesen PL, Rauch U, Bohrmann B, Kling D, Roque M, Fallon JT, et al. Blood‑borne tissue factor: Another view of thrombosis. Proc Natl Acad Sci U S A 1999;96:2311‑5. 4. Abraham E. Coagulation abnormalities in acute lung injury and sepsis. Am J Respir Cell Mol Biol 2000;22:401‑4. 5. Rijneveld AW, Weijer S, Bresser P, Florquin S, Vlasuk GP, Rote WE, et al. Local activation of the tissue factor‑factor VIIa pathway in patients with pneumonia and the effect of inhibition of this pathway in murine pneumococcal pneumonia. Crit Care Med 2006;34:1725‑30. 6. Milbrandt EB, Reade MC, Lee M, Shook SL, Angus DC, Kong L, et al. Prevalence and significance of coagulation abnormalities in community‑acquired pneumonia. Mol Med 2009;15:438‑45. 7. Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: Spectrum of complications and prognostic factors in a series of 87 cases. Brain 2003;126:1015‑25. 8. Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology 1992;42:1497‑504. 9. Abramowicz D, Pradier O, De Pauw L, Kinnaert P, Mat O, Surquin M, et al. High-dose glucocorticosteroids increase the procoagulant effects of OKT3. Kidney Int 1994;46:1596-602. 10. Barber AE, Coyle SM, Marano MA, Fischer E, Calvano SE, Fong Y, et al. Glucocorticoid therapy alters hormonal and cytokine responses to endotoxin in man. J Immunol 1993;150:1999-2006
Access this article online Quick Response Code:
Journal of Neurosciences in Rural Practice | January - March 2014 | Vol 5 | Issue 1
Website: www.ruralneuropractice.com
DOI: 10.4103/0976-3147.127933
93
Copyright of Journal of Neurosciences in Rural Practice is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
3. 4. 5.
and the forehead, associated with a frontal bone defect. Surg Neurol 1984;22:503‑8. Sari A, Dinc H, Gumele HR. Case report. Interhemispheric lipoma associated with subcutaneous lipoma. Eur Radiol 1998;8:628‑30. Mitilian D, Haddad D, Lenoir M, Boudjemaa S, Vazquez MP, Picard A. Interhemispheric lipoma associated with frontal subcutaneous lipoma. J Plast Reconstr Aesthet Surg 2009;62:e427‑9. Saatci I, Aslan C, Renda Y, Besim A. Parietal lipoma associated with cortical dysplasia and abnormal vasculature: Case report and review of the literature. AJNR Am J Neuroradiol 2000;21:1718‑21.
model. Addition of vasoconstrictive agents like triptans in the midst of this thrombogenic environment has the potential of critically reducing cerebral blood flow and, thus, needs careful thought and risk stratification before use. Deb Kumar Mojumder Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
Access this article online Quick Response Code:
Address for correspondence: Dr. Deb Kumar Mojumder, Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, 3601 4th Street, Lubbock, TX, USA. E‑mail: [email protected]
Website: www.ruralneuropractice.com
DOI: 10.4103/0976-3147.127932
References
Careful consideration for use of triptans for the control of headache in bacterial meningitis Sir, I read with great interest the article entitled “Nitrite, vasodilation, and headache in bacterial meningitis: Theoretical approach” by Viroj Wiwanitkit. [1] The author proposes a reasonable hypothesis based on literature review that vasodilatation secondary to nitrite production by bacteria can result in vasodilatation in the blood vessels and stimulation of nociceptive nerve endings in the meningeal vessel wall. As the author points out, in a rat model of pneumococcal meningitis, it was also found that zolmitriptan and naratriptan reduced the influx of leukocytes into the cerebrospinal fluid, reduced intracranial pressure, reduced brain water content, and attenuated the increase of regional cerebral blood flow.[2] Despite these benefits of the use of triptans in the animal model of meningitis, its use in patients as a cerebral vasoconstrictor needs careful thought. Pneumococcus has known thrombogenic potential via activation of the extrinsic coagulation pathway. [3‑6] Ischemic strokes have been reported in patients with pneumococcal meningitis in the past.[7,8] Steroid, used for the management of bacterial meningitis, also has a potential for activation of the extrinsic coagulation pathway,[9,10] a fact that was not tested in the rat animal
1. Wiwanitkit V. Nitrite, vasodilation, and headache in bacterial meningitis: Theoretical approach. J Neurosci Rural Pract 2013;4:374‑5. 2. Hoffmann O, Keilwerth N, Bille MB, Reuter U, Angstwurm K, Schumann RR, et al. Triptans reduce the inflammatory response in bacterial meningitis. J Cereb Blood Flow Metab 2002;22:988‑96. 3. Giesen PL, Rauch U, Bohrmann B, Kling D, Roque M, Fallon JT, et al. Blood‑borne tissue factor: Another view of thrombosis. Proc Natl Acad Sci U S A 1999;96:2311‑5. 4. Abraham E. Coagulation abnormalities in acute lung injury and sepsis. Am J Respir Cell Mol Biol 2000;22:401‑4. 5. Rijneveld AW, Weijer S, Bresser P, Florquin S, Vlasuk GP, Rote WE, et al. Local activation of the tissue factor‑factor VIIa pathway in patients with pneumonia and the effect of inhibition of this pathway in murine pneumococcal pneumonia. Crit Care Med 2006;34:1725‑30. 6. Milbrandt EB, Reade MC, Lee M, Shook SL, Angus DC, Kong L, et al. Prevalence and significance of coagulation abnormalities in community‑acquired pneumonia. Mol Med 2009;15:438‑45. 7. Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: Spectrum of complications and prognostic factors in a series of 87 cases. Brain 2003;126:1015‑25. 8. Pfister HW, Borasio GD, Dirnagl U, Bauer M, Einhaupl KM. Cerebrovascular complications of bacterial meningitis in adults. Neurology 1992;42:1497‑504. 9. Abramowicz D, Pradier O, De Pauw L, Kinnaert P, Mat O, Surquin M, et al. High-dose glucocorticosteroids increase the procoagulant effects of OKT3. Kidney Int 1994;46:1596-602. 10. Barber AE, Coyle SM, Marano MA, Fischer E, Calvano SE, Fong Y, et al. Glucocorticoid therapy alters hormonal and cytokine responses to endotoxin in man. J Immunol 1993;150:1999-2006
Access this article online Quick Response Code:
Journal of Neurosciences in Rural Practice | January - March 2014 | Vol 5 | Issue 1
Website: www.ruralneuropractice.com
DOI: 10.4103/0976-3147.127933
93
Copyright of Journal of Neurosciences in Rural Practice is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
