- 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 due to acute cerebrovascular accident, severe arterial hypertension, TBI, 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 realized 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. An irritant 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, the vital activity of pathogens, and tissue decay in oncological diseases.

Symptoms of the meningeal syndrome

The shell symptom complex is formed by cerebral manifestations and meningeal symptoms proper. Typical intense diffuse cephalgia (headache), vomiting without previous nausea. Vomiting is not accompanied by relief of the general condition of the patient. In severe cases, there is excitement, which is replaced by apathy, epileptic seizures, hallucinations, depression of consciousness to the point of stupor, coma are possible. 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 muscle-tonic symptom is stiffness (hypertonicity) of the occipital muscles, 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 in the trigger points of the trigeminal nerve, Kerer's 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 more than 30 clinical symptoms that help diagnose meningeal 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, the lower limb is passively flexed 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 of the big toe on the foot during the study according to 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 - about 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.

Meningitis is an inflammation of the membranes of the brain and spinal cord, affecting the soft arachnoid tissues and the CSF (cerebrospinal fluid) circulating between them. Also, the development of pathology can affect the roots of the cranial nerves. The infectious disease is widespread in the world, especially in the geographical area with a temperate climate.

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

Etiology of the disease

The pathology can 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;
strepto- and staphylococci;
hemophilic bacillus;
tuberculosis;
enterobacteria;
spirochetes;
rickettsia.

The aseptic type of the disease is caused by viruses:

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

Symptoms appear a few hours after the attack, in rare cases - a day later. And also children's meningitis can be caused by pathogenic fungi, malarial plasmodium or various types of helminths.

The transmission of infection occurs directly through fragments of mucus when sneezing or coughing. Pathogenic pathogens enter the body through the nasopharynx. The disease has an incubation period when symptoms have not yet manifested, and the person is contagious. And also the cause of meningitis can be a number of pathologies:

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

The development of pathology in infants is provoked by:

intrauterine infections;
prematurity of the fetus;
hypoxia in complicated childbirth.

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

Classification and characteristic symptoms

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

Feverish illness goes away with a number of symptoms, the totality of which is called meningeal syndrome. It is accompanied by an increase in intracranial pressure, irritation of the spinal roots. It can occur simultaneously with the pathology of the autonomic nervous system. The main manifestations in children:

hyperthermia (high body temperature);
photophobia;
reaction to loud sounds (startle, crying);
vomiting not associated with food intake;
rash on the skin;
epilepsy attacks are 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 the development of the disease occur in the first year of life. Diagnosis is difficult due to mild manifestations, incompetence of the mother, who does not attach importance to the first signs. The serous form does not appear in infancy. Viral meningitis, affecting the membranes of the brain, in infants is expressed by the following symptoms:

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

Also, the symptoms of meningitis in a child are characterized by excitement when touched, manifestation of irritation, constant crying. When the baby is raised by the armpits, the head involuntarily leans back and the legs are drawn in (Lessage's symptom).

Toddlers

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

A sharp jump in body temperature up to 40 degrees, chills.
Difficulty in swallowing.
Eruption on the mucous membrane of the mouth.
Strong stitching or pressing sensations in the head with phases of painful crises.
"Brain" vomiting, not associated with eating without previous nausea.

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

During adolescence

School-age children can verbally describe their condition, making it easier to make a 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 join:

redness of the throat mucosa;
swallowing is difficult;
impaired consciousness, accompanied by delirium;
numbness of the limbs, convulsions;
navicular abdomen due to painful contraction of the abdominal muscles;
in severe cases, a strong bending of the body back due to a 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;
change in breathing and heart rate.

The disease is accompanied by a severe headache, a violation of motor functions, which are expressed by tonic spasms of individual muscle groups, involuntary movements or partial paralysis due to paresis of the cranial nerves.

Existing diagnostic studies

It is not difficult to determine the disease: it is necessary to check whether the patient has characteristic symptoms. It is necessary to monitor, referring to meningeal signs. The methodology is shown in the photo.

The analysis is carried out according to the following criteria:

The tilt of the head forward meets resistance from the back of the head (muscle stiffness).
In the supine position, the leg bent at the knee resists straightening (Kernig's syndrome).
When the lower limb is flexed, the second one is synchronously exposed to the action (according to Brudzinsky).

The underlying meningeal symptoms warrant further investigation. Diagnostic activities include:

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

If necessary, hypsarrhythmia is performed on the EEG (electroencephalogram).

Treatment

If there is a suspicion of the manifestation of the disease, help should be urgent. To prevent complications in the form of epilepsy, dementia, hearing loss and other negative phenomena, therapy is carried out in stationary 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 the viral nature: "DNA-ase", "Interferon", "RN-ase" and a 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.

Meningism. Clinical significance of meningeal syndrome

Meningeal syndrome is a symptom complex that occurs when the meninges are irritated. It includes:

1. Rigidity of the neck muscles, which prevents passive flexion of the head and, in severe cases, causes the head to tilt back.

It should be remembered that stiffness of the cervical muscles, especially in the elderly, may be the result of cervical osteochondrosis or spondylosis, myositis, trauma or metastatic lesions of the cervical region, as well as parkinsonism, paratonia, tumors or congenital anomalies in the region of the craniovertebral junction (large occipital foramen). Paratonia - an increase in muscle tone caused by involuntary resistance to fast passive movements, but disappearing with slow and careful movements, occurs in patients with dementia and dyscirculatory encephalopathy. In contrast to all these conditions, only flexion of the neck is difficult with meningitis, but not its rotation or extension.

2. Kernig's symptom - the inability to fully straighten the leg at the knee joint, previously bent at a right angle in the hip and knee joints.

3. Brudzinski's symptoms: flexion of the hip and lower leg when checking for neck stiffness (upper symptom) and when checking for Kernig's symptom on the other leg (lower symptom).

4. General hyperesthesia: intolerance to bright light, loud sounds, touching the skin. If a blanket is pulled from a patient in a state of stun, then he tries to immediately take cover.

5. Reactive pain phenomena: sharp pain on palpation of the exit points of the branches of the trigeminal nerve, occipital nerves, with pressure from the inside on the anterior wall of the external auditory canal, percussion of the zygomatic arch, which is expressed in the appearance of a painful grimace.

Meningeal syndrome is often accompanied by intense headache, nausea and vomiting, signs of increased intracranial pressure - increasing depression of consciousness, bradycardia, increased systolic pressure and respiratory rhythm disturbance (Cushing's reflex), unilateral pupil dilation with loss of its reaction to light, unilateral or bilateral lesion of the abducent nerve, persistent hiccups, the appearance of signs of stagnation in the fundus.

The most common causes of meningeal syndrome are 3 groups of diseases: infections of the central nervous system (meningitis, encephalitis, brain abscess), cerebrovascular diseases (subarachnoid or intracerebral hemorrhage), traumatic brain injury. Less commonly, meningeal syndrome is caused by volumetric formations of the posterior cranial fossa, carcinomatosis and leukemic infiltration of the meninges, vasculitis.

The combination of meningeal syndrome with general symptoms of infection, primarily fever, chills, muscle pain, requires first of all the exclusion of meningitis. It should be borne in mind that at an early stage of the disease, in children, the elderly, patients suffering from alcoholism, as well as in deep coma, meningeal symptoms may be absent. In such cases, the disease may develop subacutely and manifest as progressive stunning or delirium without clear meningeal symptoms, and sometimes without fever. When taking a history, it is important to find out whether symptoms of nasopharyngitis, sinusitis, otitis media, pneumonia, or other infectious diseases preceded the onset of signs of meningitis.

Acute meningitis can be purulent (usually caused by bacteria, most often meningococci, pneumococci, Haemophilus influenzae) or serous (usually caused by viruses, most often enteroviruses, mumps viruses, lymphocytic choriomeningitis, herpes simplex, in endemic areas - tick-borne encephalitis virus). More dangerous purulent meningitis. Sometimes they proceed at lightning speed and within a few hours lead to a coma associated with severe cerebral edema. The slightest delay in starting antibiotic therapy can lead to persistent disabling complications and even death. Serous meningitis proceeds more benignly, in particular, they never cause severe depression of consciousness, epileptic seizures, damage to the cranial nerves or brain matter, and in most cases require only supportive or symptomatic therapy. Subacute developing serous meningitis can be a manifestation of neuroborreliosis, syphilis, tuberculosis, systemic lupus erythematosus, sarcoidosis, and a number of other systemic diseases.

During the examination, you need to carefully examine the skin, identify signs of otitis media, sinusitis, mastoiditis, pneumonia, measure blood pressure, and palpate regional lymph nodes. In severe cases of meningococcal meningitis, a characteristic hemorrhagic petechial and purple rash occurs, which looks like stars of various sizes and shapes and is localized on the trunk and lower extremities (in the buttocks, thighs, legs). Petechiae can also be on the mucous membranes, conjunctiva, sometimes on the palms and soles. Much less often, a similar rash is observed with meningitis caused by enteroviruses, Haemophilus influenzae, Listeria, pneumococcus, as well as with staphylococcal bacterial endocarditis, rickettsiosis, and vasculitis. In about 10% of cases, meningococcal meningitis occurs with severe meningococcemia, accompanied by extensive hemorrhages on the skin and mucous membranes, disseminated intravascular coagulation leading to hemorrhagic necrosis of internal organs, including the adrenal glands, which causes infectious toxic shock (Waterhouse-Friderichsen syndrome).

The main task of an ambulance doctor is to suspect meningitis and transport the patient as soon as possible to an infectious or specialized neuroinfectious department. In the absence of such departments, hospitalization in the neurological department is allowed. To confirm the diagnosis in the emergency room or department, a lumbar puncture is urgently performed.

However, lumbar puncture can be dangerous due to the possibility of wedging - displacement of the brain substance from one compartment of the skull to another as a result of a local increase in intracranial pressure. In this regard, it is first necessary to determine whether there are signs of acute intracranial hypertension or a volumetric process (steadily increasing focal or cerebral symptoms, signs of damage to the posterior cranial fossa - cranial nerve dysfunction, cerebellar ataxia), to examine the fundus (to identify congestive optic discs) or conduct an echoencephaloscopy (exclude the displacement of the median structures). A contraindication to puncture are signs of incipient wedging (increasing depression of consciousness, unilateral pupil dilation, respiratory rhythm disturbance, decortication or decerebration rigidity - see Part II, Coma). Complications of puncture should not be feared if it is performed with normal pupillary response, in the absence of congestive optic discs and focal neurological symptoms. The risk of wedging is less if the puncture is performed with a thin needle, 30 minutes before the puncture, mannitol (1 g / kg) is injected intravenously, and during the puncture, no more than 3-5 ml of cerebrospinal fluid (CSF) is carefully removed without removing the mandrel completely.

In purulent meningitis, CSF is turbid, predominantly contains neutrophils, and the total number of cells (cytosis) exceeds 1000 in 1 µl. In serous meningitis, the CSF is clear or opalescent, predominantly contains lymphocytes, and the cytosis is usually several hundred cells per µl. However, at an early stage, with purulent meningitis, cytosis may be low with a predominance of lymphocytes, while with serous meningitis, neutrophils may predominate in the CSF, and only a second puncture (after 8-12 hours) can avoid a diagnostic error.

Emergency care at the prehospital stage includes the maintenance of breathing and blood circulation, relief of pain, vomiting (metoclopramide, 10 mg intravenously), epileptic seizures (diazepam, 5-10 mg intravenously for 2-3 minutes), psychomotor agitation (diazepam, sodium oxybutyrate, 2 g IV, haloperidol, 5 mg IV or IM). To reduce intracranial hypertension, intravenous dexamethasone (8 mg), lasix (20-40 mg), in severe cases - mannitol (0.25-1 g / kg intravenously drip for 15-20 minutes) are administered intravenously. With a high fever, measures to reduce the temperature are necessary. When signs of infectious-toxic shock appear, it is necessary to establish intravenous fluid (isotonic sodium chloride solution, polyglucin) in combination with corticosteroids and vasopressors (mezaton, norepinephrine, dopamine). With severe arterial hypertension, you should carefully reduce blood pressure, avoiding its sharp drop. Moderate arterial hypertension does not require correction.

With a fulminant course of purulent meningitis, the first dose of an antibiotic can be administered at the prehospital stage. In immunocompetent adults, penicillin 4 million units IV (6 times a day) or ampicillin 3 g IV (4 times a day) are still the drugs of choice. However, taking into account the emergence of strains of pneumococci and meningococci resistant to penicillin, in recent years, third-generation cephalosporins have been increasingly used - for example, cefotaxime (Claforan), 2 g intravenously 4 times a day. In case of allergy to penicillin or cephalosporins, chloramphenicol is used, 1 g intravenously 3 times a day. In newborns, a combination of cefotaxime 50 mg/kg IV and ampicillin 50-100 mg/kg (4 times a day) or ampicillin and gentamicin at a dose of 1-2 mg/kg IV (3 times a day) are used, in children older than 2 months - III generation cephalosporin or a combination of ampicillin, 50-100 mg/kg and chloramphenicol, 12.5-25 mg/kg intravenously (4 times a day).

Meningeal syndrome, accompanied by fever, epileptic seizures, depression of consciousness, the appearance of signs of focal brain damage, may indicate encephalitis, most often caused by viruses. Symptoms of encephalitis usually increase over several days, but sometimes the disease has a fulminant course. The most common variant of sporadic encephalitis in adults is herpetic encephalitis, which is caused by the herpes simplex virus. Delay in starting etiotropic therapy for this disease leads to irreversible brain damage and can be fatal. Therefore, it is very important to suspect herpetic encephalitis at the prehospital stage. With herpetic encephalitis, the temporal and frontal lobes are predominantly affected, so changes in behavior, speech, taste and smell, auditory, gustatory or olfactory hallucinations can be an early manifestation of this disease. At the same time, fever, headache, confusion or stunning, partial and generalized epileptic seizures, focal symptoms (aphasia, hemiparesis) develop.

If encephalitis is suspected, urgent hospitalization is necessary in a neuroinfectious or neurological, in severe cases, in an intensive care unit. At the prehospital stage, measures are taken to maintain breathing and blood circulation, reduce intracranial pressure, stop epileptic seizures or psychomotor agitation. The diagnosis of herpes encephalitis is confirmed by polymerase chain reaction, which detects viral DNA in the CSF. With justified clinical suspicion of herpetic encephalitis, treatment with acyclovir should be started as early as possible (10 mg / kg intravenously drip 3 times a day for 14 days).

Similar symptoms are noted with bacterial endocarditis, causing septic embolism, and brain abscess. Bacterial endocarditis may be indicated by a murmur on cardiac auscultation. A brain abscess is more often observed in young people and is manifested by headache, which can be localized in half of the head or have a diffuse character, increasing focal symptoms (hemiparesis, aphasia, hemianopsia), epileptic seizures. With the formation of the capsule (by the end of the 1st-2nd week), the fever often decreases. An abscess can be suspected in patients with purulent diseases of the lungs, teeth, skin, pelvic organs, congenital heart disease with right-to-left blood shunt (tetralogy of Fallot, ventricular septal defect, etc.), reduced immunity (diabetes mellitus, malignant neoplasms, AIDS) , chronic diseases of the liver and kidneys. If a brain abscess is suspected, the patient should be hospitalized in a hospital with a neurosurgical department. Lumbar puncture for suspected brain abscess is contraindicated.

The cause of meningeal syndrome may be subarachnoid hemorrhage. Its classic manifestation is a sudden intense headache, sometimes accompanied by loss of consciousness, repeated vomiting (see Part II, Stroke). Subarachnoid hemorrhage may be associated with aneurysm rupture, occasionally it occurs with carotid dissection, leukemia and thrombocytopenia, and blood clotting disorders. The combination of meningeal syndrome with focal disorders may indicate intracerebral hemorrhage or hemorrhage in a brain tumor, and the combination of neck muscle stiffness and back pain (in the absence of headache) may indicate a rupture of a spinal arteriovenous malformation.

Headache and neck stiffness often occur with severe intracranial hypertension, especially with rapidly growing masses in the posterior cranial fossa, causing hydrocephalus and herniation of the cerebellar tonsils into the foramen magnum. An example is a hematoma of the cerebellum or an extensive ischemic stroke of the cerebellum, tumors of the posterior cranial fossa. An acute picture with a sharp headache, vomiting, stunning, stiffness of the neck muscles, sometimes fainting, can occasionally occur with colloid cysts of the third ventricle and other mobile tumors of the ventricular system. Vasculitis (idiopathic, drug-induced or neoplastic), affecting the membranes and substance of the brain, can cause focal symptoms, depression of consciousness, epileptic seizures. Diagnosis is possible by identifying extracerebral pathology (for example, pathology of the kidneys, peripheral nervous system) and laboratory testing.

Meningism I Meningism (anat. meninges)

Treatment is aimed at eliminating the causes that caused M. (infectious diseases, removing intoxication, reducing intracranial pressure in intracranial organic processes, etc.). usually favorable, M. quickly disappears with regression of the underlying disease.

Bibliography: Boyaeni nervous system, ed. P.V. Melnichuk, vol. 1-2, M., 1982; Gusev E.I., Grechko V.E. and Burd G.S. Nervous diseases, M., 1988.

II Meningism (meningismus; anat. meninges meninges)

meningeal syndrome without pathological changes in cerebrospinal fluid; observed more often with intoxication.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Meningism" is in other dictionaries:

ICD 10 R29.129.1 ICD 9 781.6781.6 MeSH ... Wikipedia

- (meningismus; anat. meninges meninges) meningeal syndrome without pathological changes in the cerebrospinal fluid; observed more often with intoxication ... Big Medical Dictionary

Meningism- (anat. meninges - meninges). Meningeal syndrome without pathological changes in the cerebrospinal fluid. Observed with intoxication ... Explanatory Dictionary of Psychiatric Terms

MENINGISM- (meningism) a state of irritation of the brain or spinal cord, in which there are symptoms of meningitis (for example, stiff neck muscles), but there is no real inflammation. This condition is common in children and is usually a symptom of ... ... Explanatory Dictionary of Medicine

A condition of irritation of the brain or spinal cord in which there are symptoms of meningitis (such as neck stiffness) but no actual inflammation. This condition is common in children and is usually a symptom of ... ... medical terms

- (late Latin infectio infection) a group of diseases that are caused by specific pathogens, characterized by contagiousness, cyclic course and the formation of post-infectious immunity. The term "infectious diseases" was introduced ... ... Medical Encyclopedia

MENINGITIS- MENINGITIS. Contents: Etiology............... 799 Menintial symptom complex....... 801 Serous M............. ...... 805 Purulent M................... 811 Epidemic spinal M. . . . . 814 Tuberculous… … Big Medical Encyclopedia

Pure culture of Neisseria meningitidis. Coloring p ... Wikipedia

- (encephalon) anterior part of the central nervous system, located in the cranial cavity. Embryology and anatomy In a four-week-old human embryo, 3 primary cerebral vesicles anterior appear in the head of the neural tube ... ... Medical Encyclopedia

- [Greek. meninx, meningos meninges + kokkos grain, bone (fetus); infection] an infectious disease, for which the most typical damage to the mucous membrane of the nasopharynx and generalization in the form of specific septicemia and purulent ... ... Medical Encyclopedia

Meningism

Meningism (meningismus; Greek meninx, meningos meninges) is a clinical manifestation of irritation of the meninges, characterized by the presence of meningeal symptoms (stiff neck, symptoms of Kernig, Brudzinski, and others) without inflammatory changes in the cerebrospinal fluid. Meningism in most cases is associated with an increase in intracranial pressure due to hyperproduction or impaired resorption of cerebrospinal fluid (hydrocephalus) or edema of the brain and its membranes. It can be observed in many infectious diseases that occur with intoxication - pneumonia, acute dysentery, salmonellosis, typhoid and typhus, tonsillitis, influenza, infectious mononucleosis and others, with brain tumors and meningeal processes in the posterior cranial fossa, with traumatic brain injuries , acute disorders of cerebral circulation.

Phenomena Meningism in infectious diseases are more common in children. Usually they occur in the acute period of the disease and persist for 2-4 days, quickly disappearing with the reverse development of the underlying disease.

With tumors of the brain stem and posterior cranial fossa, or with adhesive membrane processes in the posterior cranial fossa, meningism develops as a result of acute intracranial hypertension resulting from impaired outflow. In rare cases, a small lymphocytic or mixed pleocytosis may appear in the cerebrospinal fluid.

Edema of the brain and its membranes in traumatic brain injury also usually occurs with symptoms Meningism, which can develop even in cases where the injury is not accompanied by intrathecal hemorrhage. More often, Meningism develops immediately after an injury, but sometimes with a mild or moderate injury, some time after it; in such cases, meningeal symptoms are due to developing hyperproductive hydrocephalus.

Edema of the brain and its membranes, accompanied by symptoms Meningism, can occur with insolation, overheating, hypertension, uremia, carbon monoxide poisoning.

Diagnosis Meningismus is based on the presence of meningeal symptoms, which are usually mild and disappear quickly. For differential diagnosis with meningitis (see the full body of knowledge), the study of cerebrospinal fluid (see the full body of knowledge) and the nature of the course of the disease are of primary importance. The cerebrospinal fluid in meningismus usually leaks under increased pressure, but has a normal composition. Only sometimes there is a slight increase in protein content due to an increase in the amount of albumin, or, conversely, a decrease in the number of cells and protein (cerebrospinal fluid in hydrocephalus).

In the initial stage of meningitis, especially tuberculosis and meningococcal, when the pathogen has already penetrated the meninges, inflammatory changes in the cerebrospinal fluid may still be absent. The meningism observed in these cases appears to be caused by an excess production of cerebrospinal fluid and limited swelling of the meninges. When re-examination of cerebrospinal fluid, conducted a day later, pleocytosis and a moderately increased protein content can sometimes be detected.

Treatment comes down to lowering intracranial pressure (see full body of knowledge) and eliminating the causes of meningism. In order to lower intracranial pressure, diuretics are prescribed, of which diacarb is preferable, which inhibits the function of the vascular plexuses. Intramuscularly injected 25% solution of magnesium sulfate.

With meningism in patients with infectious diseases, a spinal puncture gives a positive effect (see the full body of knowledge); in hydrocephalus, the effect of this therapy is short-lived. If a tumor of the brainstem and posterior cranial fossa is suspected, lumbar puncture is performed only in a neurosurgical hospital.

Pokrovsky V.I.