What are meningeal signs? General cerebral signs of meningitis

Meningeal symptoms may be a sign of the development of a serious disease - meningitis. It most often affects patients childhood and male representatives. The article examines the main meningeal manifestations, using which you can distinguish an ordinary headache from a dangerous disease.

Meningeal syndrome is manifested by headache, increased sensitivity of the skin, in addition, a patient with such syndrome tends to be in a specific meningeal position: lying on your side, throwing your head back, pressing your arms to your chest, pulling your legs to your stomach.

Pain in the head is pronounced, bursting in nature, often without a clear location, and at the onset of the disease is often localized in the frontal or occipital region. Meningeal syndrome is characterized by increased pain under any strain: changing position, coughing, straining.

Patients experience severe discomfort when exposed to light, sound and other stimuli. This phenomenon is called light and sound sensitivity. At the height of pain, vomiting often occurs, and sudden, “fountain”. Unlike diseases gastrointestinal tract with meningitis it does not depend on food intake.

Technique for checking for symptoms

The doctor checks the listed symptoms in patients in horizontal position on the back. Meningeal syndrome appears in connection with reflex mechanisms.

To the most common and significant neurological signs refers to rigidity (translated from Latin rigidity, hardness) occipital muscles and meningeal symptoms: Kernig, Brudzinsky, Gillen (Guillain), “landing”, Lessage.

Kernig's symptom is named after the infectious disease doctor who discovered and described the symptom in the 19th century. The check is carried out in a certain order and consists of 2 phases:

the doctor bends the leg at the hip and knee joints at a right angle;
asks the patient to straighten the leg at the knee joint (lift it up).

If the meningeal symptom is positive, the patient cannot complete the second part of the study due to the high tone of the flexor muscles of the leg.

The next meningeal sign is Brudzinski's symptom, which was described by a pediatrician. There are 4 types: buccal, upper, middle and lower. The first is determined by pressing on the cheek under the cheekbone, while the shoulder girdle moves upward and the arm bends at the elbow. The second one, that is upper symptom, characterized by bending the legs while pressing against the abdomen while attempting to bring the patient's head toward the chest.

The third sign is also called pubic: if you press with a clenched fist on the patient’s pubis, the legs are pulled towards the front abdominal wall and their flexion at the hip and knee joints. The last or lower Brudzinski symptom with meningeal syndrome consists of pulling a straight leg towards the stomach while trying to give the limb located in the initial position bent position(Kernig's sign).

One of the meningeal symptoms was described by a French neurologist, the symptom was named after his surname - Guillain. The essence is to press on the thigh in front, while a reflex flexion of the other leg occurs at the hip and knee joints.

Significant and widespread is the ankylosing spondylitis symptom, known as “zygomatic”. It is characterized by increased headaches and a painful grimace (caused by tonic tension of the facial muscles) when tapping on the zygomatic bone. The muscle reaction is observed from the side of the percussion performed.

Features of determining changes in pediatric patients

In children, meningeal symptoms are checked according to age. There are several main meningeal signs, these are the symptoms:

"landing"- when trying to sit a child with straight legs, he bends them or tilts his body back with support on his hands;

Lessage– relevant for children in the first year of life: the baby is lifted, holding the armpits, while the legs are pulled towards the stomach and remain in this position (normally, children move their legs, simulating a search for support);
Lesage-Abrami- children are drowsy, quickly lose weight, they have disruptions in cardiovascular function;

"kiss the knee" characterized by the inability to touch the knees with the mouth while sitting.

In addition, in patients of early childhood, bulging of the large fontanelle is noted.

In addition to the listed symptoms included in meningeal syndrome, there are many other features that in some cases are detected in patients with irritation meninges. These are the symptoms:

Lafores-sharpening of facial features;
Bickel- the patient stays with his arms bent for a long time;

Blankets- the patient does not allow the blanket to be pulled off, which is typical even for patients with impaired consciousness;
Lichtenstern- tapping on the forehead provokes shuddering and increased pain;
Mann-Gurevich- deterioration of the condition when opening the eyes or moving them, accompanied by fear of light and sound;

Mendel and Mandonesi- the appearance of a painful grimace when pressing from the inside on the front wall ear canal on both sides and when pressing on the eyes;
Signorelli, Kerera, Kullenkampf: severe pain when palpating the exit points of some cranial nerves;
Levinson- opening of the mouth when trying to touch the chin to the chest.

Comprehensive diagnostics

In the presence of meningeal syndrome in clinical picture Infectious, cerebral and meningeal symptoms must be present. The latter play a leading role. During the examination, the doctor also checks tendon reflexes.

General infectious symptoms include weakness, fatigue, fever, malaise. Due to the presence of general cerebral symptoms, patients may experience impaired consciousness up to coma (with severe course and development of complications). Possible seizures, delirium, disorientation, hallucinations, psychomotor agitation.

Mandatory in diagnosis is general analysis blood, research cerebrospinal fluid. The analysis is carried out by puncture of the spinal canal, in the process the value of liquor pressure is determined.

Meningeal signs are varied. As a rule, when making a diagnosis, checking each of the listed manifestations is not necessary. Determining the main features is considered sufficient. The detected meningeal symptom complex requires laboratory research to confirm the diagnosis.

If meningitis is suspected, it is indicated urgent hospitalization patients to a specialized department or with isolation provided in the absence of conditions. Due to a life-threatening and health-threatening condition, intensive therapy and resuscitation.

The prognosis depends on several conditions (the cause of the disease, the severity of the disease and the participation of brain matter in the pathological process). In case of timely and adequate treatment, the outcome of the disease is favorable.

We hope that the information will be useful to you, and in case of the slightest suspicion, you will be able to determine the need to immediately seek qualified medical help. Take care of yourself and your loved ones!

Meningococcus can penetrate various tissues or organs human body, but most often it penetrates the brain, where it develops inflammatory process soft meninges.

Start

The disease most often begins with simple chills and an increase in body temperature to 37-40 degrees. Nasopharyngitis appears in 45% of patients within the next week. The doctor makes an initial diagnosis of acute respiratory infections. Further development:

Severe headaches and, as a result, intoxication. Intracranial hypertension.
Weakness, fatigue.
Vomiting, not accompanied by nausea, does not bring relief.
Sensitivity to stimuli (light, sound, etc.).

First day

The first day of the disease may have meningeal symptoms such as irritation of the meninges, which increases rapidly. There are four main signs that represent meningeal symptoms:

The headache intensifies after turning the head 2-3 times in a horizontal position.
The muscles of the back of the head become rigid. Simply put, increased tone head muscles does not allow the patient to bring his chin closer to his sternum.
Kernig's sign.
Brudzinski's occipital sign.

Rash

A sign in the form of a rash - small bruises that quickly increase in diameter and number against the background high temperature- indicator of meningitis. Symptoms indicate very serious illness, life-threatening person. Call an ambulance immediately!

Meningeal symptoms: description

Kernig's sign

Our Russian therapist V. M. Kernig described it. The bottom line is that the patient is unable to passively extend his legs, which were previously bent at the knee and hip joints at a right angle. It is worth knowing that newborns have Kernig syndrome as a physiological fact; it disappears at about three months of age.

Brudzinski's sign

This is another indicator included in meningeal symptoms. Brudzinski, an outstanding Polish doctor, compiled a whole table of the symptoms of the disease.

Occipital symptom - involuntary pulling of the legs towards the stomach. In this case, the patient lies on his back and passively bends his head forward.
A buccal symptom is an involuntary bending of the arms at the elbows and raising of the patient’s shoulders if you press on his cheek below the zygomatic arch.
Meningeal signs are expressed in lower symptom. If you bend the leg of a patient lying on his back at the knee, the second leg will bend involuntarily in the same joints.

Meningeal syndrome - Guillain's sign

The patient pulls his leg toward his stomach by lightly squeezing the quadriceps muscle or pinching the skin over it.

Gordon's meningeal symptoms

If you squeeze calf muscle patient, extension is observed thumb.

Hermann's sign

Passive neck flexion provokes extension thumbs legs

Symptom of the Soviet neurologist Kuimov

Light pressure on the eyes provokes a painful facial reaction.

Bekhterev's symptom

Tapping on the cheekbone worsens the headache and is accompanied by tonic contraction of the facial muscles. A grimace of pain occurs, usually on the same side of the face. The advanced disease is characterized by the meningeal “pointing dog” posture. The patient lies on his side with his knees bent and his head thrown back.

Meningeal symptoms at purulent inflammation There are a lot of descriptions of the meninges. These include neck stiffness, Kernig's sign, various options Brudzinski's symptom (upper, lower, buccal, pubic), Gillen's symptom. In addition, with meningitis there is whole line pathological reflexes described by Babinsky, Oppenheim, Rossolimo, Gordon, Bekhterev and others.

To the most important symptoms Meningitis primarily affects neck stiffness and Kernig's sign. The appearance of these signs is due to reflex muscle contraction, which protects nerve roots(cervical and lumbar) from sprains. These symptoms are also observed when the meninges are irritated by any pathological process located in the cranial cavity, such as abscess of the brain, cerebellum and others. The severity of individual meningeal signs depends in such cases on the location of the abscess and the reaction of the meninges. The study of meningeal symptoms is usually carried out with the patient positioned on his back.

Muscle stiffness the back of the head can be expressed in moderate or strong degree. In the first case, head movements are limited to the sides and forward, and in the second case, the head is thrown back. The study of this symptom is carried out with active and passive movement of the head. Rigidity of the neck muscles is easily detected by passively tilting the head forward until the chin touches the chest. With stiffness of the muscles of the back of the head, the chin does not touch the chest even in cases of moderate severity of this symptom, not to mention those cases when its intensity reaches a strong degree.

Definition Kernig's sign It is done like this: the leg is bent at a right angle at the hip, as well as at the knee, after which the examiner tries to fully straighten it at the knee joint. In this case, a reflex contraction of the flexors and pain occurs, preventing extension. When carrying out the Kernig experiment, sometimes at the same time the Edelman symptom appears, consisting of dorsal extension of the big toe.

Brudzinski, as already said, many symptoms have been suggested. However, in case of inflammation of the meninges, they are content with studying only two of them: “upper” and “lower”. The first is revealed when examining the rigidity of the muscles of the back of the head, namely, when the head is passively tilted forward. At this time, automatic bending occurs lower limbs in the hip and knee joints and pulling them towards the stomach.

Gillen's sign is caused by compression by the examining hand of the quadriceps muscle, which, as is known, occupies the entire anterior and partly lateral surface hips. In response to compression of the mentioned muscle, a contraction of the same muscle on the other leg occurs.

To the signs inflammation of the meninges, indicating a sharp increase in irritation of the sensitive area, are the symptoms described by Kulsnkampf and Knick. Kuhlenkampf described two signs. One of them is that when the knee is strongly bent towards the stomach, pain occurs, radiating to the sacrum. The second is pain when pressing on the atlanto-occipital membrane. Let us add on our own that with meningitis, pain is also often observed when palpating the spinous processes of the cervical vertebrae. Knik's sign is when pressure is applied to the area behind the angle lower jaw causes pain.
It must be emphasized that all sorts of manipulation on patients suffering from otogenic meningitis, regardless of their nature and intensity, cause discomfort and the corresponding reaction.

Pathological reflexes caused by damage nervous system, namely pyramid path. They are revealed by appropriate examinations of the foot; pathological reflexes on the hands are rarely observed and therefore do not have practical significance. The main ones are the symptoms of Babinsky, Rossolimo, Oppenheim, Bekhterev and Gordon. These reflexes have highest value V clinical practice. In the clinical picture of the disease, all pathological reflexes, or only part of them, are sometimes observed, most often the symptoms of Babinsky, Rossolimo and Oppenheim.

Separate forms of pathological reflexes or various combinations thereof are observed in severe cases of otogenic meningitis. Therefore, they have a certain significance in the neurological examination of these types of patients.
We will briefly discuss the identification method pathological reflexes. The starting position for their study is the patient's position on his back.

Video definition of meningeal symptoms

Table of contents of the topic "Stages and symptoms of otogenic meningitis":

Meningitis is a demyelinating disease of the nervous system, leading to the destruction of the myelin sheath of neurons. Treatment at home is prohibited. It is important to identify symptoms promptly and obtain urgent medical care. The difficulty of diagnosis lies in the identity of the symptoms of the disease with the flu. A common form of the disease is bacterial meningitis. It does not destroy the body, but weakens it. When found the following symptoms, consult a doctor immediately.

What are the meningeal signs and symptoms?

The disease occurs in two forms: viral and bacterial. Depending on the type, patients exhibit characteristic features. The main meningeal symptoms in adults:

severe weakness in a child and an adult;
temperature rise to 39 degrees;
aches, especially in the lumbar region;
irregular breathing rhythm, increased heart rate;
Blood clots may appear.

Meningeal symptoms in children are as follows:

strong headache, radiating to the neck, back;
vomiting due to unbearable headaches;
increased sensitivity to touch;
convulsions, hyperesthesia;
Pointer dog pose is a meningeal symptom of the development of a severe form of the disease.

Doctors combine all these symptoms into one syndrome. The combination of signs of the disease is individual for each patient. The main and most common irritations of the meninges are considered to be stiff neck, Kernig's sign. Incubation period illness lasts 2-10 days. The disease is accompanied by accompanying signals that often mislead doctors. Diagnosis is carried out during hospitalization of the patient. Treatment includes tonic measures aimed at strengthening the body.

Test in the Romberg pose

A simple diagnostic test - the Romberg test - reveals dysfunction of organ systems that are involved in maintaining balance. These include: vestibular apparatus, proprioception system (deep sensitivity), brain functions cerebral cortex. Procedure: the patient stands straight, legs together, with eyes closed extends his arms forward. Swaying, deviation to the right or left, etc. indicate damage to the cerebellum, neurological abnormalities.

Kernig's sign

One of important signs disorders of the meninges - Kernig's sign. Named in honor of the Russian therapist V.M. Kernig. Method of implementation: the patient, lying on his back, bends his leg at the joints 90 degrees. Next, the doctor attempts to straighten the leg. With meningitis this cannot be done. The analysis is positive to an equal extent on both sides of the test. Occurs on early stages development of meningitis.

Babinski reflex and asynergia

Babinsky asynergy is performed in the following way: The patient lying on his back is crossed with his arms and asked to sit down. On the affected side, the patient's lower limbs rise. Another interpretation: when pushing back or falling, the patient with damage to the cerebellum falls backward. There is no bending of the knee joints to maintain balance. Asynergia – indicates difficulties in performing combined movements. Happens on initial stage development of meningitis and other diseases.

Brudzinski's sign

The combination of signs resulting from brain damage is Brudzinski’s symptom. Occurs in several diseases at once. The following types are distinguished:

Upper. It manifests itself as involuntary bending of the legs, pulling towards the stomach while hanging (lowering) the head down.
Average. When pressure is applied to the pubis, the legs bend.
Lower. When checking, a Kerning symptom is revealed on one side, on the other - the leg, bending, is pulled towards the stomach.
Buccal. When you press on the zygomatic arch, your shoulders rise and your arms bend.

Muscle stiffness

It appears in almost 80% of cases. Indicates irritation of the membranes of the brain, disorders of the central nervous system. Rigidity of the neck muscles is determined with the patient in a supine position. When passively bending the head, tension occurs in the muscles of the neck and occipital muscles. They prevent the chin from moving towards the chest. Muscle rigidity cervical region often accompanied by tightening of the muscles of the back and limbs. False rigidity also occurs in the presence of spondyloarthrosis, spondylosis of the cervical spine.

Rossolimo's symptom

The finger reflex is caused by striking the fingers on the phalanges of the 2-5 toes of the patient's foot. The patient's reaction is to flex the sole or in rare cases their abduction. The patient is examined in a lying position. All fingers or 2 and 5, one thumb can participate in the movement. Healthy individuals have no symptoms. The symptom is a pathological flexion type, manifested when the pyramidal tract is damaged. Second option: the symptom is determined on the patient’s hands.

Oppenheim's sign

During the analysis, extension of the big toe is observed during irritation of the medial surface of the leg. Method of implementation: with the phalanx of the large or index finger the doctor performs sliding movements from top to bottom along the medial surface of the leg with force. The norm is to bend the fingers. With meningitis, extension of the toes occurs with a slight turn of the foot. Oppenheim's sign is similar to Babinski's reflex. The reflex occurs in most lesions of cerebral activity.

Video about meningeal symptoms

Every doctor should know meningeal symptoms. This group of symptoms has vital importance in neuroscience. Meningal symptoms occur when the membranes of the brain are irritated. Irritation usually appears as a result of meningitis, but it can be triggered, for example, by hemorrhage inside the brain or the disintegration of a tumor. Meningeal signs are of great importance for diagnosing the disease. At the slightest inflammation meningeal membranes the patient must be examined, especially for children. Today medicine has identified more than 30 symptoms. Meningeal signs are usually named after the author who discovered them. About the most significant symptoms will be discussed below.

Kernig's symptoms are typical not only for children and patients who develop meningitis, but also for people with problems in the knee joints. Meningeal Kernig syndrome makes it possible to establish accurate diagnosis in children and adults. The essence of this syndrome is that when bending and extending the knee, hip joint(with the help of a doctor) there is no full straightening of the leg. This meningeal syndrome is being studied in 2 stages.

First, the doctor bends the patient's leg while he is lying on his stomach, and then releases the pressure and releases the leg, which begins to passively extend.

In healthy children and adults, this syndrome does not manifest itself, and the leg calmly returns to its original position. Kernig 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 pathological change nerve tissue, and in what dynamics the disease develops.

Other options

Meningeal Strumpel syndrome manifests itself as slowly progressive lower spastic paraplegia. Hand function is preserved. The cranial innervation remains preserved. On late stages Urinary incontinence may occur. Sometimes there is a decrease in pain. The symptom is checked by pressing knee-joint. It is diagnosed if the fingers fan out when pressed, as well as spontaneous extension of the big toe. When the form of the pathology is complex, hearing loss may join the symptoms, cerebellar ataxia, ichthyosis, etc.

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

Catarrhal inflammation of the respiratory tract.
General weakness, fatigue, malaise.
Increase in body temperature to extreme values.
Failure in the functioning of the gastrointestinal tract.

Meningeal Guillain syndrome in children and adults manifests itself at the initial stage general weakness in the muscles of the limbs, which indicates destruction nerve cells. In the later stages of pathology development, loss of sensation in the limbs occurs. Another meningeal symptom is called Mendelian symptom. Character traits development pathological condition are that children or an adult patient develops Blunt pain in the area of the appendix. Nausea and vomiting may develop. May appear on the tongue white coating. Next meningeal sign- Flatau's symptom. The symptom manifests itself in the dilation of the patient’s pupils when he passively or intensively bends his head.

Checking for meningeal symptoms is very important. Brudzinski's symptoms test not only the target organ, but also all systems, because usually the lesion affects the membranes of the brain and the entire body as a whole. Brudzinski's signs are checked as follows:

Top sign. The patient should lie on his back and try to touch his chin to his chest. If inflammation of the membranes is present, then the leg will involuntarily bend at the knee and hip joint.
Average sign. The patient is gently pressed on the pubis. Inflammation is present if he pulls his legs towards his stomach.
The lower sign is checked as Kernig's sign.
Buccal sign. The patient is pressed on the area under the cheekbone, and if inflammation of the membranes of the brain is present, then the sick person’s arm will bend or the hand will rise.

These signs were introduced into practice by the Polish doctor Joseph Brudzinski. Since the beginning of the 20th century, they have been standard in diagnosis.

Another meningeal syndrome that allows the diagnosis of meningitis is a stiff neck. It can be checked by bending the patient's head from a supine position. The doctor tries to pull the patient's head towards chest, but if there is rigidity (high muscle tone), then this will not work. When checking, a lifting of the body may be noticed. Neck stiffness is of great importance in the diagnosis of cerebral hemorrhage and meningitis.

The next symptom is the recumbent dog pose. With severe damage to the nervous system, the functioning of the entire body is disrupted.

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

Opisthotonus, trismus of masticatory muscles

Opisthotonus is a posture characterized by the head thrown back, bending in spinal column and extension of the lower extremities. A person takes this position when there is inflammation of the membranes of the brain, meningitis, tumors, tetanus or hemorrhagic stroke. Rarely does a person take such a position when he is experiencing hysterical attack. In children, opisthotonus occurs when purulent meningitis or tetanus, indicates brain damage. Another symptom of inflammation of the meninges is trismus. masticatory muscles. It manifests itself as a spasm of these muscles and an inability to move the jaw freely. The potty symptom usually occurs in children who are sick bacterial meningitis. When the baby sits on the potty, he quickly tries to lean on the floor behind his back.

He does this in order to avoid tension in the muscles in the back of his head. Levinson's symptom is very important in the diagnosis of viral, bacterial and tuberculous meningitis. The symptom is checked very simply. The patient, when trying to pull his head towards the chest, involuntarily opens his mouth. This sign is not specific and is used in difficult cases. For serous, tuberculous, Bickel. Its development occurs when there is serious inflammation of the meninges. Sometimes Bickel's sign occurs with cerebral hemorrhage. The symptom is expressed by constantly bending the elbows. Also, the patient constantly wants to hold the blanket being pulled off him. This condition remains the same even if the patient is in a feverish state.

Thanks to all of the above symptoms, it is possible to promptly diagnose life-threatening pathologies and prescribe treatment. After all, treatment started on time gives an 80% successful outcome.