Meningeal symptoms. Hardening of the neck muscles

– a symptom complex characteristic of damage to the cerebral membranes. It may have an infectious, toxic, liquor-hypertensive, vascular, traumatic, carcinomatous etiology. Manifested by headache, muscle rigidity, vomiting, hyperesthesia, algic phenomena. The diagnostic basis is made up of clinical data and research results cerebrospinal fluid. Treatment is carried out according to the etiology with antibacterial, antiviral, antifungal, antiprotozoal agents, including symptomatic therapy, decrease intracranial pressure.

Treatment of meningeal syndrome

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

Etiotropic treatment. At bacterial etiology antibiotic therapy is prescribed wide range, viral – antiviral agents, fungal - antimycotics. Detoxification and treatment of the underlying disease are carried out. Before the pathogen is identified, etiotropic therapy is carried out empirically, after clarification of the diagnosis - in accordance with the etiology.
Decongestant therapy. Necessary to prevent cerebral edema, aimed at reducing intracranial pressure. It is carried out with diuretics and glucocorticosteroids.
Symptomatic therapy. Aimed at relieving emerging symptoms. Hyperthermia is an indication for the use of antipyretics, arterial hypertension is antihypertensive drugs, repeated vomiting - antiemetics. Psychomotor agitation docked psychotropic drugs, epileptic paroxysm - anticonvulsants.

Prognosis and prevention

In most cases, timely and correct treatment leads to the patient’s recovery. It may take several months residual effects: asthenia, emotional lability, cephalgia, intracranial hypertension. An unfavorable outcome is meningeal syndrome accompanying serious disease CNS, fulminant course infectious process, oncopathology. Prevention of meningeal syndrome includes increasing immunity, preventing infectious diseases, injuries, intoxications, timely therapy cerebrovascular and cardiovascular pathology. Specific prevention possible against meningococcal and pneumococcal infections.

Modern medicine is able to eliminate or stop most existing pathological processes. Countless medications, physiotherapeutic procedures, etc. have been created for this. However, many therapy methods are most effective on early stages development of the disease. Among such pathological processes, meningeal syndrome can be distinguished. It is a complex of manifestations characteristic of irritation meninges. Among its causes are meningitis, meningism and pseudomeningeal syndrome. The last type is a consequence mental disorders, pathologies of the spine, etc. Inflammation of the meninges is characteristic only of the first 2 types, so it is recommended to find out what meningeal symptoms exist in order to identify the problem in time and begin treatment.

Meningeal syndrome, regardless of the cause, is expressed by certain symptoms. The first signs of the disease look like in the following way:

Feeling of aching throughout the body, as if you have a cold;
General lethargy and fatigue even after sleep;
Increased heart rate;
Disturbances in the respiratory system;
Temperature rise above 39º.

Gradually, meningeal symptoms (signs) appear more and more intensely and new ones are added to the previous signs:

Manifestation of convulsive attacks. This symptom occurs mainly in children. For adults, its occurrence is considered rare;
Adopting a meningeal position;
Development of abnormal reflexes;
The occurrence of a headache. This symptom is the main one and manifests itself extremely intensely. The pain intensifies mainly due to external stimuli, for example, light, vibration, sound, sudden movements, etc. The nature of the pain is usually acute and it can radiate to other parts of the body (neck, arms, back);
Vomiting due to severe headache;
Development of hypersensitivity (hyperesthesia) to light, vibration, touch, sounds, etc.
Rigidity (petrification) of the muscle tissue of the back of the head.

The combination of these symptoms represents meningeal syndrome. The degree of manifestation and combination of symptoms may be different, since this pathological process has many causes. The presence of pathology is determined mainly using instrumental examination (lumbar puncture, MRI, etc.), but initially you should pay attention to its main manifestations.

Main features

During the examination, the doctor focuses on the following signs:

Bekhterev's symptom. It is determined by easy tapping on cheekbones. At the same time, the patient begins to have an attack of headache and facial expressions change;
Brudzinski's sign. It is divided into 3 types:
- Top form. If you put the patient on the couch and ask him to stretch his head to his chest, then along with this movement his legs will involuntarily bend at the knee joint;
- Zygomatic shape. This sign is actually similar to Bekhterev's symptom;
- Pubic shape. If you press on the pubic area, the patient will reflexively bend over lower limbs in the knee joint.
Fanconi's sign. A person is unable to sit up independently if he is in a lying position (with his knees bent or fixed);
Knik's sign. To check for this sign, the doctor applies light pressure around the corner. lower jaw. With meningeal syndrome, this action causes acute pain;
Gillen's sign. Such a sign meningeal syndrome The doctor checks by squeezing the quadriceps muscle on the front of the thigh. At the same time, the patient contracts the same muscle on the other leg.

Among other symptoms characteristic of inflammation of the meninges, two main manifestations of the pathological process described by Klunekamf can be distinguished.

The essence of the first sign is that when the patient tries to stretch his knee to his stomach, painful sensations, echoing in sacral region. A feature of the second symptom is pain when pressing on the atlanto-occipital membrane.

Kernig's symptom is considered one of the first manifestations of the pathological process. Its essence lies in the inability to independently straighten the lower limb if it is bent at an angle of 90º at the hip and knee joint. Kids have this meningeal sign may not appear at all. In infants up to 6-8 weeks and in children suffering from Parkinson's disease or myotonia, Kernig's sign is a consequence of excessively high muscle tone.

Hardening of the neck muscles

The muscle tissue located in the back of the head begins to harden with meningeal syndrome. This problem arises due to an abnormal increase in their tone. The occipital muscles are responsible for straightening the head, so the patient, due to its rigidity, cannot calmly bend his head, since he arches along with this movement upper half bodies.

For people suffering from meningeal syndrome, a certain position is characteristic, in which the intensity of pain decreases:

Pressed to chest hands;
Body arched forward;
Intracted abdomen;
Head thrown back;
Lower limbs raised closer to the stomach.

Features of symptoms in children

In children, meningeal manifestations are predominantly a consequence of meningitis. One of the main signs of the disease is Lesage's symptom. If you press on the baby's armpits, his legs reflexively rise towards his stomach, and his head is thrown back a little. An equally important manifestation is Flatau's symptom. If the child tilts his head forward too quickly, his pupils will dilate.

The most characteristic sign of meningeal syndrome is a swollen fontanelle (the area between the parietal and frontal bone). Other symptoms may be less pronounced or absent. Among the frequently encountered signs are seizures, vomiting, elevated temperature, weakening of the muscles of the limbs (paresis), moodiness, irritability, etc.

In newborns, meningitis occurs as follows:

Initially, the pathological process manifests itself with signs characteristic of a cold and poisoning (fever, vomiting, etc.);
Gradually, children's appetite worsens. They become lethargic, moody and a little inhibited.

In the first days of development of the pathology, symptoms may be mild or completely absent. Over time, the child’s condition will worsen and neurotoxicosis with its characteristic neurological symptoms will appear.

Meningeal signs depend on the cause of the disease, but in general they are virtually the same. In most cases, the symptoms manifest themselves extremely intensely, but people, not knowing about the possible pathological process They don’t go to the doctor until the last minute. In such a situation, the consequences are often irreversible, and in the case of a child, he may even die. That is why it is extremely important to know how the disease manifests itself in order to begin a course of treatment in a timely manner.

Meningitis is an inflammation of the membranes of the brain and spinal cord, affecting the soft arachnoid tissues and the cerebrospinal fluid circulating between them ( cerebrospinal fluid). Also, the development of pathology can affect the roots cranial nerves. Infection widespread in the world, especially in temperate geographic areas.

The anomaly is transmitted through the nasopharynx, so winter and early autumn are more dangerous time years for infection. The course of the disease can take the form of sporadic (irregular) or epidemic endemic. Most often it occurs in the first year of life, and recedes after four years. The next increase in infection occurs at the end of adolescence.

Etiology of the disease

The pathology may be based on various pathogens that begin to develop against the background of a weakened immune system. Responsible for bacterial meningitis in children:

pneumo- and meningococci;
streptococci and staphylococci;
hemophilus influenzae;
tuberculosis;
enterobacteria;
spirochetes;
Rickettsia.

The aseptic type of disease is caused by viruses:

enterovirus infection;
microorganism Coxsackie;
mumps, or so-called mumps;
polio;
encephalitis tick bite;
chicken pox;
rubella;
measles;
adeno- and ECHO viruses;
herpes.

Symptoms appear several hours after the attack, in in rare cases- in a day. And childhood meningitis may be caused by pathogenic fungi, Plasmodium falciparum or various types helminths.

The infection is transmitted directly through mucus fragments when sneezing or coughing. Pathological pathogens enter the body through the nasopharynx. The disease has an incubation period, when symptoms have not yet appeared and the person is contagious. A number of pathologies can also cause meningitis:

inflammatory infections in the respiratory system;
otitis, adenoiditis;
abnormal structure of the skull, deviated nasal septum, sinusitis;
furunculosis localized on the front part, caries;
avitaminosis.

The development of pathology in infants is provoked by:

intrauterine infections;
fetal prematurity;
hypoxia during complicated childbirth.

IN early age contributes to the disease poor care, hypothermia, climate change and excessive physical exercise. The anomaly occurs against the background of an unformed immune system and weak resistance of the blood-brain barrier.

Classification and characteristic symptoms

The disease differs according to the place of localization, time of course and cause of occurrence: Primary and secondary forms of pathology are determined by frequency, the initial ones are based on neuroviral and bacterial causes. Repeated is a complication of influenza, syphilis or tuberculosis.
The condition of the cerebrospinal fluid is characterized by purulent, hemorrhagic, serous meningitis.
Period of course: reactive, acute and chronic.
Form of infection: hematogenous, contact, perineural, lymphogenous, traumatic brain injury.
Generalized and limited are determined along the border of the affected area.

A febrile illness occurs with a number of symptoms, the totality of which is called meningeal syndrome. Accompanied by increased intracranial pressure, irritation spinal roots. May occur simultaneously with vegetative pathology nervous system. Main manifestations in children:

hyperthermia ( heat body);
photophobia;
reaction to loud sounds(shuddering, crying);
vomiting not associated with food intake;
rash on the skin;
seizures of epilepsy cannot be excluded.

Symptoms of meningitis in a child depend on the type of pathology and the age of the patient.

In infants

The main cases of development of the disease occur in the first year of life. Diagnosis is difficult due to mild manifestations and the incompetence of the mother, who does not attach importance to the first signs. Serous form does not appear in infancy. Viral meningitis, affecting the membranes of the brain, in children infancy is expressed by the following symptoms:

refusal of food and water, regurgitation, diarrhea;
periodic vomiting;
yellowing skin, rash;
the occipital muscles are toned;
weakness, drowsiness, hypotension (lethargy);
temperature increase;
convulsions;
tension of the cranial fontanel;
hydrocephalic cry.

Also, symptoms of meningitis in a child are characterized by agitation when touched, irritation, and constant crying. When lifting a baby by the armpits, the head involuntarily throws back and the legs tighten (Lessage's symptom).

In babies

From one to 5 years, the infection can be bacterial or caused by the ECHO and Coxsackie viruses. Clinical picture accompanied brightly pronounced signs, the disease develops quickly. If during inflammatory process is formed purulent fluid in the brain, determined serous meningitis with characteristic symptoms:

A sharp jump in body temperature to 40 degrees, chills.
Difficulty in swallowing.
Rash on the oral mucosa.
Strong stabbing or pressing sensations in the head with phases of pain crises.
"Brain" vomiting not associated with food intake without previous nausea.

Symptoms of meningitis in children are complemented by pallor of the skin and pathological muscle reflexes to certain movements.

During adolescence

Children school age can verbally describe their condition, which facilitates diagnosis. Inflammation of the meninges manifests itself quickly, with characteristic signs, hyperthermia up to 40 degrees and toxic syndrome(vomiting). Then the following symptoms of meningitis in adolescents are added:

redness of the throat mucosa;
swallowing is difficult;
disturbance of consciousness accompanied by delirium;
numbness of limbs, convulsions;
navicular abdomen due to painful contraction abdominal muscles;
in severe cases, severe backward bending of the body due to generalized spasm in the back;
redness and swelling of the face, rash on the skin and mucous membranes;
yellow color of the skin and whites of the eyes;
joint pain, swollen lymph nodes;
changes in breathing rhythm and heart rate.

The disease is accompanied by severe headache, disturbance motor functions which are expressed by tonic spasms of individual muscle groups, involuntary movements or partial paralysis due to cranial nerve palsy.

Existing diagnostic tests

Determining the disease is not difficult: you need to check whether the patient has characteristic symptoms. It is necessary to carry out monitoring, referring to meningeal signs. The procedure is shown in the photo.

The analysis is carried out according to the following criteria:

Tilt of the head forward meets resistance from the back of the head (muscle rigidity).
When lying on your back, the leg bent at the knee resists straightening (Kernig's syndrome).
When the lower limb is flexed, the second limb is simultaneously affected (according to Brudzinsky).

The main meningeal symptoms are a reason for further investigation. Diagnostic activities include:

lumbar puncture of the spinal cord and brain;
cerebrospinal fluid cytology;
computed tomography;
blood test to detect antibodies (immunological);
scraping from the mucous membrane for diplococcus.

If necessary, hypsarrhythmia is performed using an EEG (electroencephalogram).

Treatment

If there is a suspicion of a disease, help should be urgent. To prevent complications such as epilepsy, dementia, hearing loss and others negative phenomena therapy is carried out in inpatient conditions. The patient is prescribed bed rest, a dropper is used to relieve intoxication. Treatment is carried out with drugs:

Antibacterial action: “Mernem”, “Ceftriaxone”, “Chloramphenicol”.
Against viral nature: “DNAase”, “Interferon”, “RNAase” and lytic mixture.
Painkillers and antipyretics: “Acetylene”, “Paracetamol”, “Panadol”.
Sedatives: “Seduxen”, “Dikam”, Diazepam.”
Corticosteroid hormones: Novomethasone, Dexamethasone, Methylprednisolone.
Antifungal: Diflucan, Fungolon, Flucostat.

Therapy is carried out with an individual dosage and course of treatment under the supervision of a physician.

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 frequently manifested irritations of the meninges are rigidity occipital muscles, 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 in the early stages of meningitis.

Babinski reflex and asynergia

Babinsky's asynergy is performed as follows: 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 stiffness cervical spine 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 soles or, in rare cases, abduct them. 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 is observed thumb foot 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

Inflammation and damage to the membranes of the brain are more than serious problems that require complex and surgical treatment. Meningeal symptoms make it possible to reliably diagnose the disease and begin treatment on time. They may appear due to too high pressure or as a result of hemorrhage. Some of them can be recognized independently, while others cannot be identified without the intervention of a specialist.

Main symptoms of meningeal syndrome

There are many symptoms of meningeal syndrome, and most of them are unique. That is, it is quite difficult to confuse the signs of meningeal syndrome with any other diseases. Many specialists have studied the disease. The most common symptoms they were able to identify are:

The main symptom of meningeal syndrome is stiffness of the neck and neck muscles. Symptoms may be severe or moderate degree. Rigidity of the neck muscles is easy to recognize: the patient cannot touch his chin to his chest. Moreover, contact does not occur even if the symptom is mild. And in patients with pronounced rigidity of the muscles of the back of the head, the head may always be slightly thrown back.
People suffering from meningeal syndrome very often complain of. In most cases painful sensations spread all over the head, but sometimes can concentrate in one place: the back of the head, temples, frontal part. In some patients, the headache is accompanied by vomiting, which may be impossible to combat.
Another common meningeal symptom is Kernig's. It consists in the inability to straighten a leg bent at the knee. It is not difficult to determine the symptom: the patient needs to bend his leg at ninety degrees and try to straighten it. With meningeal syndrome, this is unrealistic: while trying to straighten knee-joint the leg bends involuntarily, and the patient feels pain.
Gillen's symptom is considered a sure sign of meningeal syndrome. Its presence is checked by pressing the quadriceps femoris muscle. If a person really suffers from meningeal syndrome, he will involuntarily bend his leg at the knee and bring it to his chest. The test is carried out for the patient in a supine position.
Neurologists can also determine meningeal syndrome using Bekhterev's symptom. With light tapping on the zygomatic arch, the headache intensifies, and the face contorts in a painful grimace.
Fanconi's symptom indicates a disease if the patient cannot rise with the fixed knee joints extended.

Brudzinski's meningeal symptoms

Most specialists begin diagnosing meningeal syndrome by checking the four main Brudzinski symptoms.