Neuroinfektiöse Krankheiten

Abstrakt

Structural Protein and Growth Factor Expression Patterns Leads to Extracellular Matrix Remodeling and Attendant Cerebral Vasculitis in Bacterial Meningitis

Vivig Shantha Kumar, Vignarth Shantha Kumar

Cerebrovascular complications of bacterial meningitis account for an overwhelmingly high incidence of post infectious neurological decline amongst survivors. From several pieces of histological descriptions, angiographic models and radiographic studies, it is clear that the cerebral vessels are distinctively involved during the course of bacterial meningitis. Furthermore, it is evident that dynamic vessel wall changes take place during the course of infection with an early transient vasospasm and a more persistent vasculitis through angiographic studies documenting time course variations of cerebral blood flow. Even with this, our understanding of the deleterious vessel wall modifications predisposing to vasculitis in bacterial meningitis remains to be more closely elucidated. Interestingly, after analyzing a temporal relationship between subarachnoid space inflammation and cerebral vasculopathy in bacterial meningitis, it becomes somewhat definite that the development of cerebral vasculitis may originate from inflammatory byproducts synthesized in the subarachnoid space. Following synthesis and release of these soluble growth factors, they are relayed into surrounding penetrating cerebral vessels, where they subsequently gain access to specific components of the extracellular matrix to initiate the progressive process of vessel wall remodeling, eventually culminating in the development of ischemic consequences. With this, in this review, we specifically sought to understand the significance of disturbed expression of specific structural proteins and growth factors in the subarachnoid space and their potential role in triggering vasculitic adaptations of the cerebral vasculature.