How to recognize meningeal signs and symptoms. Meningitis - symptoms and treatment in children, prevention measures What is meningeal syndrome

- a symptom complex characteristic of lesions of the cerebral membranes. May have an infectious, toxic, CSF-hypertensive, vascular, traumatic, carcinomatous etiology. Manifested by headache, muscle rigidity, vomiting, hyperesthesia, algic phenomena. The diagnostic basis is clinical data, the results of the study of cerebrospinal fluid. Treatment is carried out according to the etiology with antibacterial, antiviral, antifungal, antiprotozoal agents, includes symptomatic therapy, reduction of intracranial pressure.

General information

Meningeal (shell) syndrome is a common pathology faced by neurologists, infectious disease specialists, pediatricians, general practitioners, otolaryngologists and many other specialists. The syndrome got its name from the Latin term "meningea", denoting the membranes of the brain. In cases where the meningeal syndrome is caused by irritation of the cerebral membranes without their inflammatory changes, the definition of meningism is used in medical practice. The peak of active study of pathology occurred at the end of the 19th century; various authors proposed numerous specific symptoms of the disease that are still used today. Meningeal syndrome occurs at any age without gender preference. In elderly patients, it has an erased clinical picture.

Causes of meningeal syndrome

Etiofactors are many intracranial and polysystemic pathological processes. Most often, meningeal syndrome provokes inflammation of the meninges (meningitis), subarachnoid hemorrhage, traumatic brain injury. In accordance with the effect on the cerebral membranes, the etiological causes are divided into two main groups - inflammatory and non-inflammatory lesions.

Inflammatory lesions:

• Bacterial. Nonspecific - due to meningococcal infection, Haemophilus influenzae, streptococci, pneumococci, in newborns - salmonella, Escherichia coli. Specific - arising from penetration into the membranes of pathogens tuberculosis, syphilis.
• Viral. In 75% of cases, they are provoked by enteroviruses, less often by Epstein-Barr virus, arenavirus, herpes infection, tick-borne encephalitis virus.
• fungal. The main pathogens are cryptococci, candida, aspergillus, histoplasma. Cause serous inflammation of the membranes with petechial hemorrhages.
• Protozoan. Observed in toxoplasmosis, malaria.

Non-inflammatory lesions:

• Hemorrhages in the meninges. May occur as a result of acute cerebral circulation, severe arterial hypertension, head injury, cerebral vasculitis.
• intracranial hypertension. It develops as a result of hydrocephalus, volumetric formations (brain tumors, intracranial cysts, abscesses, intracerebral hematomas).
• intoxication. Exogenous - paint and varnish production, substance abuse, alcoholism. Endogenous - uremia, hypoparathyroidism.
• Neurotoxicosis with common infectious diseases (flu, typhus, dysentery, SARS).
• Carcinomatosis- infiltration of the cerebral membranes by tumor cells in various oncological processes, including leukocyte infiltration in neuroleukemia.

Pathogenesis

Meningeal syndrome has two mechanisms of development. The first - the inflammatory process - is implemented in response to the penetration of infectious agents. Infection of the cerebral membranes occurs by contact (with open head injury, osteomyelitis of the bones of the skull), lymphogenous, perineural, hematogenous routes. The drift of pathogens with blood flow is more often observed in the presence of foci of purulent infection (sinusitis, purulent otitis media, mastoiditis). With encephalitis, inflammation in the substance of the brain extends to the tissues of the membranes with the development of meningoencephalitis. The second pathogenetic mechanism is irritation of the meninges. The irritating effect is exerted by accumulations of blood during subarachnoid hemorrhage, an increase in intracranial pressure, toxic substances entering the body from outside or resulting from dysmetabolic processes, vital activity of pathogenic microorganisms, tissue decay during oncological diseases.

Symptoms of the meningeal syndrome

The shell symptom complex is formed by cerebral manifestations and meningeal symptoms proper. Intense diffuse cephalgia is typical ( headache), vomiting without previous nausea. Vomiting not accompanied by relief general condition sick. In severe cases, there is excitement, followed by apathy, possible epileptic seizures, hallucinations, oppression of consciousness to stupor, coma. The pathognomonic symptoms characterizing the meningeal syndrome include three groups of symptoms: signs of hyperesthesia, muscular-tonic manifestations, pain phenomena.

Hyperesthesia is manifested by increased susceptibility to sounds (hyperacusia), light (photophobia), and touch. The most common muscular-tonic symptom stiffness (hypertonicity) of the occipital muscles appears, which is detected when trying to passively bend the patient's head. An increase in muscle tone determines a typical position: lying on its side with an arched back, head thrown back, limbs bent and brought to the body (“Position of a pointing dog”). Reactive algic symptoms include soreness of the eyes with movement and pressure on the eyelids, pain at trigger points trigeminal nerve, Kerer points on the back of the head, in the cheekbones.

Diagnostics

Meningeal syndrome is diagnosed by specialists in the field of infectology, pediatrics, neurology, therapy. On examination, attention is paid to the presence of meningeal posture, hyperesthesia, pain and tonic phenomena. Hypertonicity of meningeal genesis is differentiated from muscle tension that accompanies myositis, sciatica. In the neurological status, characteristic changes in the reflex sphere are determined: the revival of reflexes, followed by their uneven decrease. If the meningeal syndrome is associated with damage to the substance of the brain, then a corresponding focal neurological deficit is detected (pyramidal insufficiency, aphasia, cerebellar ataxia, paresis of the facial nerve). There are over 30 clinical symptoms helping to diagnose the shell syndrome. The most widely used among neurologists and general practitioners are the following:

• Kernig's sign- in the position of the patient lying on his back, passively bend lower limb in the hip and knee joint. Subsequent attempts by the doctor to straighten the leg at the knee are impossible due to tonic contraction of the muscles that flex the lower leg.
• Brudzinsky's symptoms- in the position on the back, involuntary pulling of the lower extremities to the stomach is noted when the patient's head is bent (upper), pressing on the pubis (middle), checking Kernig's symptom (lower).
• Symptom of Edelman- extension thumb on the foot during examination by the method of Kernig.
• Netter's sign- in a sitting position with legs extended in bed, pressing on the knee of one leg causes bending of the other.
• Symptom Kholodenko- bending the knees when the doctor tries to lift the patient by the shoulders.
• Guillain's symptom- in the position of the patient on the back with straightened legs, the compression of the muscles of the anterior surface of one thigh leads to the flexion of the second leg.
• Symptom Lessage- when holding the child in the air in a vertical position by the armpits, the legs are pulled to the stomach. Typical for young children.

The most important role in the diagnosis of shell syndrome is played by lumbar puncture. It is contraindicated in severe intracranial hypertension, the danger of a mass effect, is carried out after the exclusion of these conditions according to ophthalmoscopy and echoencephalography. The study of cerebrospinal fluid helps to establish the etiology of the syndrome. Cloudy cerebrospinal fluid with a predominance of neutrophils indicates purulent, opalescent with an increased content of lymphocytes - the serous nature of inflammation. An admixture of blood is observed with subarachnoid hemorrhage, cancer cells - with oncological lesions.

Meningeal syndrome is differentiated by etiology. Verification of the final diagnosis is achieved with the help of bacteriological and virological examination of cerebrospinal fluid, blood culture, PCR studies, electroencephalography, MRI of the brain.

Treatment of meningeal syndrome

An advanced meningeal symptom complex requires treatment in a hospital. Therapy is carried out differentiated taking into account the etiology and clinical manifestations, includes the following areas:

• Etiotropic treatment. In case of bacterial etiology, antibiotic therapy is prescribed with broad-spectrum drugs, viral - antiviral agents, fungal - antimycotics. Produced detoxification, treatment of the underlying disease. Before the pathogen is established, etiotropic therapy is carried out empirically, after the diagnosis is clarified, in accordance with the etiology.
• Decongestive therapy. Necessary to prevent cerebral edema, aimed at reducing intracranial pressure. It is carried out with diuretics, glucocorticosteroids.
• Symptomatic therapy. It is aimed at stopping the emerging symptoms. Hyperthermia is an indication for the use of antipyretics, arterial hypertension - antihypertensive drugs, repeated vomiting - antiemetics. Psychomotor agitation is stopped by psychotropic drugs, epileptic paroxysm - anticonvulsants.

Forecast and prevention

In most cases, promptly initiated correct treatment leads to the recovery of the patient. For several months, residual effects may be observed: asthenia, emotional lability, cephalalgia, intracranial hypertension. An unfavorable outcome has a meningeal syndrome that accompanies a severe disease of the central nervous system, a fulminant course of the infectious process, and oncopathology. Prevention of the shell syndrome includes an increase in immunity, prevention of infectious diseases, injuries, intoxications, timely treatment of cerebrovascular and cardiovascular pathologies. Specific prophylaxis is possible in relation to meningococcal, pneumococcal infections.

Meningeal symptoms should be known to every doctor. This group of symptoms is of great importance in neurology. Meningeal symptoms occur when the meninges are irritated. Irritation appears, usually as a result of meningitis, but can be triggered, for example, by a hemorrhage inside the brain or the collapse of a tumor. Meningeal signs are of great importance for diagnosing the disease. At the slightest inflammation of the meningeal membranes, the patient should be examined, especially for children. Today, medicine has identified more than 30 symptoms. Meningeal signs are usually named after the author who discovered it. The most significant symptoms will be discussed below.

Kernig's symptomatology is typical not only for children and patients who develop meningitis, but also for people with problems in the knee joints. Meningeal Kernig syndrome allows you to establish an accurate diagnosis in children and adults. The essence of this syndrome is that when bending and unbending the knee, hip joint (with the help of a doctor), there is no complete straightening of the leg. This meningeal syndrome is being investigated in 2 stages.

First, the doctor flexes the leg of the patient lying on his stomach, and then relieves pressure and releases the leg, which begins to passively unbend.

In healthy children and adults, this syndrome does not manifest itself, and the leg calmly returns to its original position. Kernig's syndrome allows not only to diagnose the presence of meningitis, but also to determine the extent to which the brain is affected by the infection. In addition, it is possible to determine the prognosis of pathological changes in the nervous tissue, and in what dynamics the disease develops.

Other options

Shtrumpel's meningeal syndrome is manifested by slowly progressive lower spastic paraplegia. Hand function is preserved. The cranial innervation remains intact. In later stages, urinary incontinence may occur. Sometimes a decline pain. The symptom is checked by pressing on the knee joint. Inflammation of the meninges is diagnosed if, when pressed, the fingers open like a fan, as well as in spontaneous extension of the big toe. When the form of the pathology is complex, then hearing loss, cerebellar ataxia, ichthyosis, etc. can join the symptoms.

Meningeal Guillain syndrome in children and adults is manifested by the following symptoms:

1. Catarrh of the respiratory tract.
2. General weakness, fatigue, malaise.
3. An increase in body temperature to extreme values.
4. Failure in the functioning of the gastrointestinal tract.

Guillain's meningeal syndrome in children and adults initial stage manifested by general weakness in the muscles of the limbs, which indicates the destruction of nerve cells. In the later stages of the development of pathology, loss of sensitivity in the limbs is added. Another meningeal symptom is called Mendel's symptom. Characteristic features of the development of the pathological condition are that in children or an adult patient, a dull pain develops in the area of ​​\u200b\u200bthe appendix. Nausea and vomiting may develop. A white coating may appear on the tongue. The next meningeal symptom is Flatau's symptom. A symptom is manifested in the expansion of the pupils of the patient, when he passively or intensively bends his head.

Checking for meningeal symptoms is very important. Brudzinsky's symptomatology checks not only the target organ, but also all systems, because usually the lesion concerns the membranes of the brain and the whole organism as a whole. Brudzinsky's signs are checked as follows:

1. Top sign. The patient should lie on his back and try to reach his chest with his chin. If inflammation of the membranes is present, then his leg will involuntarily bend at the knee and hip joint.
2. Average sign. The patient is lightly pressed on the pubis. Inflammation is present if he pulls his legs to his stomach.
3. The lower sign is tested as Kernig's sign.
4. Cheek sign. The patient is pressed on the area under the cheekbone, and if inflammation of the meninges is present, then the arm of the sick person will bend or the hand will rise.

These signs were introduced into practice by the Polish doctor Josef Brudzinsky. Since the early 20th century, they have been standard in diagnosing meningitis in children and adults.

Another meningeal syndrome that makes it possible to diagnose meningitis is neck stiffness. It can be checked by bending the patient's head from a supine position. The doctor is trying to pull the patient's head to chest, but if there is rigidity (high muscle tone), then this will not work. Elevation of the body may be seen on examination. Neck stiffness is of great importance in the diagnosis of cerebral hemorrhage and meningitis.

The next symptom is the lying dog posture. For severe injuries nervous system disruption of the entire body.

With meningeal syndrome, there is an increase in muscle tone, and the patient acquires the position of a lying dog, or otherwise the position of a cocked trigger. This position indicates that meningitis is extremely difficult. The symptom is unfavorable.

Opisthotonus, trismus of chewing muscles

Opisthotonus is a posture characterized by the head thrown back, the deflection in the spinal column and the extension of the lower extremities. A person takes this position for inflammation of the meninges, meningitis, tumors, tetanus, or hemorrhagic stroke. Rarely does a person take such a position when he has a hysterical fit. In children, opisthotonus manifests itself with purulent meningitis or tetanus, indicating brain damage. Another symptom of inflammation of the meninges is lockjaw of the masticatory muscles. It manifests itself as a spasm of these muscles, the inability to freely move the jaw. Potty symptom usually occurs in children who have bacterial meningitis. When the baby sits on the potty, he quickly tries to lean on the floor behind his back.

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He does this in order to avoid muscle tension in the back of the head. Levinson's symptom is very important in the diagnosis of viral, bacterial and tuberculous meningitis. The symptom is very easy to check. The patient, when trying to pull his head to the chest, involuntarily opens his mouth. This feature is not specific and is used in difficult cases. With serous, tuberculous, viral meningitis, Bickel's symptom is manifested. Its development occurs when there is a serious inflammation of the meninges. Sometimes Bickel's symptom manifests itself with cerebral hemorrhage. The sign is expressed by arms constantly bent at the elbows. Also, the patient constantly wants to keep the blanket pulled off him. This state remains the same even if the patient is in a feverish state.

Thanks to all of the above symptoms, life-threatening pathologies can be diagnosed in a timely manner and treatment can be prescribed. After all, treatment started on time gives a successful outcome by 80%.

Meningitis is one of the most serious diseases that can lead to dangerous complications and even death. Its treatment at home is unacceptable, so it is important to recognize the disease in time. But the danger is that the first signs of meningitis are very similar to those of the flu. Characteristic features irritations of the meninges are meningeal symptoms.

How does meningitis start?

• There are several forms of meningitis disease. Most often, regardless of the form, the first signs of meningitis are general infectious symptoms:
• acute attack of weakness
• a sharp rise in temperature to 39 degrees
• aches all over the body
• rapid heart rate and irregular breathing

Within a few hours or days, the patient develops symptoms caused by irritation of the meninges:

• which is intensifying. This is a sharp, intense, arching pain that can radiate to the neck, back, less often to the limbs.
• Vomiting that occurs during worsening headache
• Hyperesthesia (increased sensitivity to touch and light stimuli)
• Stiff neck
• Meningeal posture, symptoms of Kernig, Brudzinsky, zygomatic symptom of Bekhterev, etc.
• Seizures (common in children, rare in adults)

Doctors group these symptoms into meningeal syndrome. The combination of symptoms in meningitis can vary. The main and most constant signs of irritation of the meninges are stiff neck and Kernig's symptom.

Consider the main meningeal symptoms in more detail.

Stiff neck

Due to the reflex increase, which are responsible for the extension of the head, there is stiffness of the occipital muscles. An attempt to bend the head of a sick person lying on his back leads to the fact that the upper body rises along with the head.

Rigidity of the occipital muscles causes a meningeal posture, which manifests itself:

• head thrown back
• Arched torso
• "Scaphoid" retracted abdomen
• Hands pressed to the chest, legs pulled up to the stomach

Kerning symptom

This early symptom damage to the meninges is expressed in the inability of the patient to straighten the leg at the knee joint, which was bent by another person at a right angle in the hip and knee joints.

However, in young children, Kernig's symptom may not appear. And in children under 2 months of age, as well as in people with Parkinson's disease and myotonia, this meningeal symptom may not be a sign of meningitis, but a consequence of a physiological or pathological increase in muscle tone.

Other meningeal symptoms include:

• Zygomatic symptom of Bekhterev. When tapping the zygomatic arch, the headache intensifies and an involuntary painful grimace occurs on the corresponding part of the face
• Upper symptom of Brudzinsky. An attempt to bring the head to the chest of the patient, who is in a prone position, causes involuntary bending of the legs at the knees.
• Brudzinsky's zygomatic symptom. The same reaction when tapping the zygomatic arch
• Pubic symptom of Brudzinsky. In response to pressure on the pubic joint, the legs bend at the knees.
• Fanconi sign. The patient is unable to sit up on his own in bed with knees extended and fixed.

Features of meningeal symptoms in children

Meningitis in young children is accompanied by Le Sage's suspension symptom. A sick child, raised under the armpits, pulls his legs to his stomach and holds them in this position, and slightly throws his head back.

In addition, young children are characterized by such a sign of meningitis as Flatau's symptom - dilated pupils with a quick tilt of the head forward.

A characteristic sign of meningitis in infants is a prolonged and persistent bulging of the large fontanel.

However, some meningeal symptoms in young children may not be. The main signs of meningitis in them are convulsions, vomiting with a fountain, regurgitation, constriction of the pupils, paresis of the limbs, changes in the nature of the child's cry.

The diagnosis of meningitis disease is confirmed by the results of the analysis of cerebrospinal fluid.

Elena Kukuevitskaya

Clinical aspects differential diagnosis meningeal symptom complex (MSC) as the most common and important syndrome practical infectology remain relevant to the present day. The main reasons for close attention to this syndrome are: an increase in the number of infectious and non-infectious diseases in which MSCs occur, a high incidence of complications of the pathology manifested by MSCs, including deaths, untimely diagnosis and the associated delayed treatment of the underlying pathology, leading to disability. Of particular relevance is the preclinical diagnosis of MSCs in last years due to the increasing frequency of enteroviral, herpetic, arbovirus, meningococcal and other neuroinfections.

meningeal syndrome(MS) is an irritation of nerve receptors in the pia mater due to its undifferentiated inflammatory process. Etiologically, the diagnosis (MS) is established on the basis of a combination of the following clinical and pathogenetic syndromes: [ 1 ] syndromes of an infectious disease (general infectious symptoms: malaise, irritability, flushing of the face, fever, shift of the blood formula to the left, bradycardia, then tachycardia and arrhythmia, increased respiration, in severe cases - Cheyne-Stokes respiration) [ 2 ] meningeal (shell) syndrome; [ 3 ] changes in cerebrospinal fluid.

MS underlies the clinical picture acute forms meningitis, regardless of their etiology. This syndrome, combined with cerebral, and often local symptoms, can vary in the severity of its individual components within the widest range. Cerebral symptoms are an expression of the reaction of the nervous system to infection due to intoxication, cerebral edema, damage to the soft meninges and impaired liquorodynamics. The main elements of MS are: headache, vomiting, muscle contractures, changes in the cerebrospinal fluid.

However, it should be remembered that, despite the fact that MS is a symptom complex that reflects diffuse lesions of the membranes of the brain and spinal cord, MS can be caused by an inflammatory process (meningitis, meningoencephalitis), due to the different microbial flora (in the case of inflammation, the etiological factor there may be bacteria - bacterial meningitis, viruses - viral meningitis, fungi - fungal meningitis, protozoa - toxoplasma, amoeba), however, MS can be caused by non-inflammatory lesions of the meninges. In these cases, the term "meningism" is used.

More about the symptom complex M FROM:

MS consists of cerebral and meningeal symptoms proper. The cerebral symptoms include a very intense, excruciating headache of a bursting, diffuse nature, vomiting, often without previous nausea, which does not bring relief to the patient; In severe cases, psychomotor agitation, delirium, hallucinations, convulsions, periodically replaced by lethargy and impaired consciousness (stupor, stupor, coma).

Actually meningeal symptoms can be divided into 4 groups. To the 1st group General hyperesthesia refers to hypersensitivity to sensory stimuli with light (photophobia), sound (hyperacusia), and tactile stimuli. In severe meningitis, the patient's posture is very characteristic: the head is thrown back, the trunk is maximally extended, incl. legs. Within the framework of these symptoms, the Fanconi phenomenon is characteristic: (tested with the patient lying on his back): in the presence of a positive symptom, the patient cannot sit up in bed on his own with extended and fixed knee joints; and a symptom of Amoss: the patient can sit in bed only leaning on both hands (in the “tripod” position) and cannot reach his knee with his lips. To the 2nd group meningeal symptoms include neck stiffness, Kernig's symptom, Brudzinsky's symptoms upper, middle and lower (Kernig's symptom: the patient lies on his back with the leg bent at the hip and knee joints at an angle of 90 °, due to a painful reaction, it is not possible to straighten the limb in the knee joint up to 180 °; Brudzinsky's symptoms (checked in a patient lying on his back): distinguish between upper, middle and lower symptoms, upper: an attempt to tilt the head to the chest leads to flexion of the lower extremities in the knee and hip joints; middle (pubic): when pressing on pubis, flexion (adduction) of the legs in the knee and hip joints occurs; lower (contralateral): with passive extension of the leg bent at the knee and hip joints, involuntary flexion (pulling) of the other leg in the same joints occurs). Rigidity of the long muscles of the back leads to the fact that the patient is bent backwards and cannot bend forward. In children, tension and protrusion of the large fontanel are also noted as a manifestation of intracranial hypertension. When meningeal symptoms are detected, it is necessary to differentiate tonic muscle tension from false muscle stiffness caused by pain (myositis, radiculitis, etc.), which can simulate neck muscle stiffness. To the 3rd group meningeal symptoms include reactive pain phenomena: soreness with pressure on the eyeballs, at the exit points of the branches of the trigeminal nerve on the face, at the exit points of the large occipital nerves (Kerer's points); on the anterior wall of the external auditory canal (Mendel's symptom); increased headache and painful grimace with percussion of the zygomatic arches (Bekhterev's symptom) and the skull (Pulatov's symptom). To the 4th group meningeal symptoms include changes in abdominal, periosteal and tendon reflexes: first, their revival, and then an uneven decrease.

Remember! Meningism- the presence of meningeal symptoms in the absence of signs of inflammation in the CSF, with its normal cellular and biochemical composition. Meningism can be with the following conditions (diseases): [ 1 ] irritation of the meninges and changes in CSF pressure: subarachnoid hemorrhage, acute hypertensive encephalopathy, occlusive syndrome during volumetric processes in the cranial cavity (tumor, parenchymal or intrathecal hematoma, abscess, etc.), carcinomatosis (sarcoidosis, melanomatosis) of the meninges, pseudotumor syndrome, radiation encephalopathy; [ 2 ] toxic process: exogenous intoxications (alcohol, hyperhydration, etc.), endogenous intoxications (hypoparathyroidism, malignant neoplasms, etc.), infectious diseases that are not accompanied by damage to the meninges (influenza, salmonellosis, etc.); [ 3 ] pseudomeningeal syndrome (there is no irritation of the membranes itself, there is only a symptomatology similar to meningeal signs due to other causes: mental [paratonia], vertebrogenic [for example, spondylosis], etc.).

The diagnosis begins in the emergency room of the infectious diseases hospital. If there is no doubt about the presence of meningitis, which is confirmed by the available anamnestic and objective data, a decision is made to urgently perform a lumbar puncture. Diagnostic lumbar puncture should also be performed in the unconscious state of the patient. Spinal puncture is delayed if there is a suspicion of the absence of meningitis if the patient has a characteristic clinical triad (headache, vomiting, fever), stiff neck, positive symptoms of Kernig, Brudzinsky. A similar picture is characteristic of meningism, which is based on toxic irritation of the meninges. Meningism can be observed in various common acute infectious diseases (influenza, SARS, pneumonia, dysinteria, viral hepatitis, etc.) or during exacerbations chronic diseases.

An additional sign of meningism may be the dissociation of the meningial syndrome, which is expressed between the presence of stiff neck and upper Brudzinski's symptom, and the absence of Kernig's symptom and lower Brudzinski's symptom. Differentiation of meningism from meningitis is possible only on the basis of a study of the cerebrospinal fluid (CSF). During lumbar puncture, in most patients, an increase in intracranial pressure (up to 250 mm of water column) is determined, with normal cytosis and a slight decrease in protein (below 0.1 g / l). A characteristic feature of meningism should be considered a rapid (within 1 - 2 days) disappearance of symptoms with a drop in temperature and a decrease in intoxication. The possibility of recurrence of meningism with repeated diseases is not excluded.

Conclusion:

Meningeal syndrome is caused by both an inflammatory process caused by various microbial flora (meningitis, meningoencephalitis) and non-inflammatory lesions of the meninges.

Some infectious and non-infectious diseases occur with the presence of a meningeal symptom, which in turn complicates the correct diagnosis.

The diagnosis should be based on clinical data, taking into account the totality of clinical, epidemiological and laboratory data, including consultations of narrow specialists.

Remember!

Pathogenesis. There are 3 ways of infection of the meningeal membranes: 1. with open craniocerebral and vertebral-spinal injuries, with fractures and cracks in the base of the skull, accompanied by liquorrhea; 2. contact, perineural and lymphogenous spread of pathogens to the meningeal membranes with an existing purulent infection paranasal sinuses nose, middle ear or mastoid process, eyeball, etc.; 3. hematogenous spread.

The pathogenetic mechanisms of clinical manifestations of meningitis include: 1. inflammation and swelling of the meninges; 2. discirculation in the cerebral and meningeal vessels; 3. hypersecretion of cerebrospinal fluid and a delay in its resorption, which leads to the development of dropsy of the brain and an increase in intracerebral pressure; 4. re-irritation of the meninges and roots of the cranial and spinal nerves; 5. general impact of intoxication.

Diagnosis of meningitis is based on the identification of the following syndromes:

General infectious - chills, fever, fever, lethargy (asthenia), tachycardia, tachypneous inflammatory changes in the nasopharynx, gastrointestinal tract and in peripheral blood (leukocytosis, increased ESR, etc.), sometimes skin rashes;

cerebral - headache, vomiting, general hyperesthesia (to light, sound and touch), convulsions, impaired vital functions, changes in consciousness (psychomotor agitation, depression), bulging and tension of the fontanel;

shell (meningeal) - meningeal posture ("pose of a pointing dog"), stiffness of the neck muscles, symptoms of Kernig, Brudzinsky (upper, middle, lower), Lesage's symptom of "suspension" in children;

inflammatory changes in the cerebrospinal fluid - cell-protein dissociation - an increase in the number of cells (neutrophils in purulent and lymphocytes in serous meningitis) and protein, but to a lesser extent than the content of cells.

Meningeal syndrome is a symptom complex that occurs when the meninges are irritated. The pathology treatment scheme depends on the form of its manifestation and the causes of occurrence. The syndrome manifests itself in any type of meningitis.

The concept of meningeal syndrome

The concept of the syndrome includes the following symptoms:

• cerebral;
• general infectious;
• meningeal.

Along with the listed signs, there is a violation of the dynamics of the cerebrospinal fluid and pathological changes in the spinal cord.

Cerebral symptoms - the reaction of the central nervous system to inflammatory processes occurring in the membranes of the brain. With any type of meningitis, there are signs inherent in infectious diseases.

Meningeal symptoms are manifested by an increased reaction of the sense organs to external factors, a change in reflex functions and muscle tension.

The reasons

The main cause of the syndrome is irritation of the meninges. There is also the concept of "meningism", in which the lining of the brain is irritated, but the composition of the cerebrospinal fluid remains unchanged and there is no real inflammation. It happens as a result:

• heat stroke;
• overconsumption liquids against the background of its difficult excretion from the body;
• post-puncture syndrome;
• infections, passing in a severe form - typhus, salmonellosis, etc.;
• poisoning alcoholic drinks;
• suremia- the presence in human blood of toxins that are not excreted by the organs of the urinary system;
• acute enfalopathy;
• malignant tumors;
• strong allergic reactions;
• defeat radiation;
• subarachnoid hemorrhages.

Some pathologies have a clinical picture similar to meningeal syndrome. But these signs are not associated with brain damage. Such symptoms are called "pseudomeningeal". They arise due to damage to the frontal part of the brain, pathologies of the spine and some neurological problems.

The principle of development of meningeal syndrome has not yet been studied. Some scientists believe that the symptoms of Lesage, Kernig are a protective reaction of the body, which allows you to reduce the tension of the roots of the spinal cord, thereby easing pain.

Others believe that Kernig's symptom is due to muscle dysfunction due to abnormal functioning of the brain stem and other parts of it.

It is also believed that these signs appear as a result of high blood pressure in the liquor channel. Pathological condition arises due to increased production liquor and toxic poisoning of the meninges.

Clinical picture

Since the meningeal syndrome consists of several types of symptoms, the clinical picture of each of them should be considered separately.

Cerebral symptoms

The main symptom of damage to brain structures is a headache. Its character, as a rule, is bursting, and the place of localization is fuzzy. In this case, the patient feels a strong pressure on the eyes.

At first, uncomfortable sensations appear periodically, and then they are observed constantly and become resistant to taking any painkillers. In the morning, the intensity of attacks may be slightly higher than in the evening.

This is explained simply - after sleep, when a person spent a long time in horizontal position, the outflow of biological fluids from the brain worsens.

After the patient takes vertical position, the process of lymph circulation is restored, in turn, the headache is reduced.

Common symptoms also include:

1. Vomiting and nausea. This condition with meningitis is easy to distinguish from similar symptoms in case of poisoning or pathologies of the gastrointestinal tract. Vomiting with brain damage is not associated with eating and often manifests itself in the morning when the person's stomach is empty. Nausea with headaches is observed almost constantly. At the same time, there is no feeling of discomfort and bloating in the abdomen, appetite is not disturbed.
2. Severe headache and dizziness. The condition is caused by increased pressure inside the skull and obstructed blood supply to the brain. With meningitis, it does not have any features that distinguish it from dizziness in other pathologies.
3. Problems with eyesight- necessarily appear in violation of the brain. They make themselves felt in the later stages of meningitis, when the processes cover most of the organ.
4. Violation psyche as a result of increased intracranial pressure. Initially, the symptom makes itself felt by loss of memory, attention. Patients become distracted, unable to concentrate on any business. As the disease progresses and hypertension within the skull increases, depression of consciousness may develop.

Epileptic seizures are observed in 1/3 of patients with meningitis. The condition tends to recur from time to time. This sign is considered the most unfavorable and dangerous of all symptoms of damage to brain structures.

General infectious complex

Common infectious complex symptoms include:

• increased body temperature;
• feverish state;
• feeling of chills;
• spasm of the muscles of the epidermis;
• weakness;
• rash on the skin.

Any skin rash at elevated body temperature may indicate the development meningococcal infection. In 40% of cases, the rash is hemorrhagic in nature and manifests itself in the form of small subcutaneous hemorrhages, similar to asterisks.

meningeal symptoms

To talk about the development of infection in the human body allows the presence of meningeal symptoms. If they appear together with cerebral and general infectious signs, then the diagnosis is considered to be reliably established. A detailed description of the most common signs of a meningeal symptom is presented in the table.

Not all of these signs appear at the same time when infected with an infection. They can be masked behind general infectious or cerebral symptoms of pathology. When the patient loses consciousness, many of the above symptoms lose their significance. The main feature of the meningeal clinical picture is a sharp deterioration in the condition.

Signs of pathology largely depend on the type of microorganism that has entered the membranes of the brain. But even all three groups of symptoms are sometimes not enough to make a final diagnosis. Therefore, if an infection is suspected, the doctor prescribes a laboratory study of the cerebrospinal fluid to the patient.

Features of the development of the syndrome in children

In children, meningitis occurs with some features:

1. General infectious signs - a sharp rise in temperature, tachycardia, loss of appetite. At the same time, the child's skin becomes paler, and hemorrhagic rashes often appear on its surface. There may also be non-specific signs of infection - renal or respiratory failure, severe stool disorder.
2. cerebral syndrome - characterized by severe headaches, vomiting and impaired consciousness. When a disease occurs in children, convulsions are often observed, the intensity of which can vary from slight twitching of individual muscles to epileptic seizures.
3. Meningeal symptoms are most typical for sick children. A child affected by an infection assumes a "cocked-cocked position" - lying on its side with its head thrown back and limbs bent. Due to the increased pressure inside the skull, infants have a protrusion of the fontanel and protrusion of the veins on the eyelids and head.

Purulent meningitis in children can progress with the addition of secondary forms of infection - sepsis, pneumonia, arthritis. The most serious consequences of the pathology are a complete violation of the intellect, paralysis of the limbs, damage to the facial nerves.

Diagnosis of the syndrome

To determine meningitis, specialists resort to the following diagnostic methods:

1. Anamnesis. The patient is diagnosed with the presence of chronic diseases and infectious pathologies transferred in the recent past.
2. Visual inspection. It includes a consultation with a neurologist, an analysis of the somatic state (pulse, skin condition, blood pressure), examination of the mucous membranes of the nasopharynx, oral cavity.
3. Laboratory analysis. The most important test for detecting meningitis is a lumbar puncture for further analysis of the cerebrospinal fluid.
4. Instrumental tests - MRI or CT, x-ray of the skull, echoencephaloscopy.

With meningeal syndrome of a purulent type, turbidity of the CSF is noted. CSF analysis shows a high content of neutrophils in the substance and an overestimated number of cells over protein. In the serous type of disease, the CSF is clear in color and consists predominantly of lymphocytes.

Cytosis in this case is 200-300 cells per 1 µl. To make the results of the examination more reliable, 8-12 hours after the lumbar puncture, the procedure is repeated.

Therapy

Until now, many deaths from bacterial meningitis have been recorded. Treatment is complicated by not always clear clinical picture. Children may not have many signs of infection

The algorithm for the treatment of meningeal syndrome in adults and children is as follows:

1. Hospitalization patient in a medical facility.
2. Definition the reasons the development of the disease.
3. Holding lumbar puncture in the absence of prohibitions to the procedure.
4. Purpose drugs according to the cause of meningitis and test results.

The basis of the treatment of infection is the elimination of its symptoms and the fight against the causative agent of the disease. To do this, the doctor prescribes to the patient:

• antibiotics;
• painkillers;
• B vitamins;
• detoxification agents;
• anticonvulsants;
• hormone therapy;
• dehydration activities.

With an increase in intracranial pressure to critical levels, cerebrospinal fluid is pumped out. Before the patient enters the hospital, he must be given first aid - to support the work of the lungs and heart, reduce the intensity pain symptoms and temperature, eliminate vomiting. With the rapid progression of meningitis, the patient is given the first dose of antimicrobials.

To reduce intracranial pressure, Lasix or Dexamethasone is administered intravenously, in severe forms of the disease - Mannitol. If the patient has symptoms of infectious-toxic shock, then intravenously he is injected with a solution of sodium chloride or Polyglucin together with vasopressors.

Meningeal syndrome cannot occur for no reason, some factors affecting its development lead the patient to death. Therefore, if signs of meningeal syndrome are found, it is urgent to consult a doctor. Self-treatment of the infection is unacceptable.