Meningeal syndrome. Meningism, causes of meningism

Modern medicine can 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 this:

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 lightly tapping the 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 in 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 the lower limbs at the knee joint.
Fanconi's sign. A person is not able to sit down independently if he is in a lying position (with his knees bent or fixed);
Knik's sign. To check for the presence of this sign, the doctor applies light pressure behind the angle of the lower jaw. With meningeal syndrome, this action causes acute pain;
Gillen's sign. The doctor checks this sign of meningeal syndrome by squeezing the quadriceps muscle on the front surface of the thigh. At the same time, the patient contracts the same muscle tissue 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 the patient, when trying to stretch his knee to his stomach, experiences pain that radiates into the 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 a child tilts his head forward too quickly, his pupils will dilate.

The most characteristic sign of meningeal syndrome is a swollen fontanel (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 a possible pathological process, do not 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.

I. Meningitis (meningeal + liquor syndromes).

II. Meningism (pseudomeningitis):

A) Caused by physical reasons:

Insolation.
Water intoxication.
Postpuncture syndrome.

B) Caused by somatic reasons:

Intoxication (uremia, alcohol).
Infectious diseases
(flu, salmonellosis, dysentery and others).
“Hypertensive crisis” (transient ischemic attacks in arterial hypertension) and acute hypertensive encephalopathy.
Hypoparathyroidism.

C) Caused by neurological diseases (swelling and irritation of the membranes):

Hypertensive-occlusive syndrome in volumetric processes, vascular accidents, brain injuries, carcinomatosis and sarcoidosis of the membranes.
Pseudotumor cerebri.
Radiation damage.

D) Caused by other (rare) reasons: severe allergies, etc.

III. Pseudomeningeal syndrome (pseudo-Kernig in processes in the frontal lobe of various natures, increased tone of the neck extensor muscles in some neurological, vertebrogenic and even mental diseases).

I. Meningeal syndrome

Meningeal syndrome (meningeal irritation syndrome) is most often caused by an inflammatory process in the membranes of the brain due to bacterial or viral infections (bacterial or viral meningitis). But it can also develop as a reaction to a foreign substance in the subarachnoid space (subarachnoid hemorrhage, injection medicines, contrast material, spinal anesthetics). It is also characteristic of aseptic meningitis (meningeal pleocytosis syndrome without bacterial or fungal infection) and meningism (meningeal irritation syndrome without pleocytosis).

Meningeal irritation syndrome includes following symptoms: headaches with stiffness and pain in the neck; irritability; skin hyperesthesia; photophobia; phonophobia; fever and other manifestations of infection; nausea and vomiting, confusion, delirium, seizures, coma. Complete meningeal syndrome also includes characteristic changes cerebrospinal fluid (CSF syndrome) and the following signs of irritation of the meninges: stiffness of the neck muscles; resistance to passive leg extension; Kernig's sign (the leg does not extend at the knee joint more than 135°); Bikel's symptom (Bikele) - an analogue of Kernig's symptom on the hands; upper symptom Brudzinsky; lower symptom Brudzinsky; reciprocal contralateral Brudzinski's sign on the legs; buccal Brudzinski sign; symphyseal Brudzinski sign; Guillain's sign; Edelman thumb phenomenon.

Two-thirds of patients with bacterial meningitis have a triad of symptoms: fever, neck stiffness and impaired consciousness. It is helpful to remember that neck stiffness is often absent in infants younger than 6 months. Cervical spondylosis in the elderly makes it difficult to assess neck muscle stiffness.

CSF examination - the only way, allowing you to confirm the diagnosis of meningitis and identify the pathogen. For differential diagnostic purposes (to exclude an abscess, tumor, etc.), CT or MRI are used. In the cerebrospinal fluid, cytosis, protein and sugar content are examined, and bacteriological (and virological) and serological studies are carried out. Necessarily microscopic examination cerebrospinal fluid. Papilledema is observed in only 4% of cases bacterial meningitis in adults. Somatic examination often provides clues to the nature of meningitis. Diagnosis and treatment of meningitis cannot be delayed.

Differential diagnosis bacterial meningitis should include viral infections central nervous system, traumatic brain injury, subdural hematoma, brain abscess, febrile seizures in children, sepsis, Reye's syndrome, metabolic encephalopathy, acute hypertensive encephalopathy, intoxication, subarachnoid hemorrhage, carcinomatous meningitis.

II. Meningism

Meningism is a syndrome of meningeal irritation in which no changes in the cerebrospinal fluid are observed (pseudomeningitis).

Excessive insolation can lead to heat stroke, which is characterized by hyperemia and swelling of the membranes and brain tissue. Severe forms heatstroke begin suddenly, sometimes apoplectiformly. Consciousness may be impaired from mild degrees to coma; possible psychomotor agitation or psychotic disorders, epileptic seizures; meningeal syndrome. Body temperature rises to 41-42° and higher. Heat stroke usually occurs during periods of maximum heat exposure and only during in rare cases in the period after overheating.

Water intoxication occurs when excess water is introduced into the body (with a relative deficiency of electrolytes), especially against the background of insufficient fluid secretion (oliguria with adrenal insufficiency; kidney disease; the use of vasopressin or its hypersecretion after injury or surgery). The water content in the blood plasma increases; hyponatremia and hypokalemia occur; Blood hypoosmolarity is characteristic. Apathy, stupor, headache, cramps, and meningeal syndrome develop. Characterized by nausea that worsens after drinking fresh water, and vomiting that does not bring relief. In severe cases, pulmonary edema, ascites, and hydrothorax develop.

Postpuncture syndrome sometimes manifests itself with symptoms of mild meningism, which usually goes away on its own after a few days.

Somatic causes of meningism are most often associated with endogenous (uremia) or exogenous intoxication (alcohol or its surrogates), intoxication due to infectious diseases (influenza, salmonellosis, dysentery, etc.). Transient ischemic attack in patients hypertension rarely accompanied by symptoms of meningeal irritation. Acute hypertensive encephalopathy develops over several hours and is manifested by headache, nausea, vomiting, meningism, impaired consciousness against a background of high blood pressure (diastolic pressure 120-150 mm Hg. column and above) and symptoms of cerebral edema (CT, MRI, papilledema). Focal neurological symptoms not typical. Impaired consciousness ranges from mild confusion to coma. Differential diagnosis carried out with subarachnoid hemorrhage, acute alcohol intoxication and other conditions.

Hypoparathyroidism reflects a lack of function parathyroid glands and is characterized by a decrease in calcium levels in the blood. Reasons: surgery on thyroid gland(secondary hypoparathyroidism), autoimmune thyroiditis Hashimoto's and Addison's pernicious anemia. Among the various neurological manifestations hypocalcemia in hypoparathyroidism (tetany with muscle spasms and laryngospasms, myopathy, disturbances of consciousness, psychotic disorders, hemichorea, intracranial calcification and even epileptic seizures) increased intracranial pressure with swelling of the optic discs has also been described. The development of pseudotumor cerebri is possible. Clinical manifestations of the latest complications of hypoparathyroidism may sometimes include mild symptoms of irritation of the meninges.

Such neurological diseases as subarachnoid hemorrhage, as well as hypertensive-occlusive syndrome in volumetric processes, vascular accidents, brain injuries, carcinomatosis and sarcoidosis of the membranes are accompanied by a distinct meningeal syndrome. These diseases are usually recognized clinically, or using neuroimaging and general somatic examination.

Radiation damage to the brain most often develops in connection with the treatment of brain tumors and is manifested by a transient worsening of the symptoms of the underlying disease (tumor), epileptic seizures and signs of increased intracranial pressure, which is presumably associated with cerebral edema (although the latter is not confirmed by MRI data). Symptoms of meningismus (an early complication of therapy) may sometimes be present here. An increase in intracranial pressure is sometimes observed against the background of late (progressive dementia, ataxia, urinary incontinence, panhypopituitarism) complications (3 months - 3 years after therapy) of radiation therapy. Late complications associated mainly with the development of multifocal zones of necrosis in the brain tissue.

III. Pseudomeningeal syndrome

Pseudomeningeal syndrome is most often discussed in connection with increased tone in the posterior cervical muscles in the absence of true symptoms irritation of the meninges (meningismus). Such a symptom may be a manifestation of paratonia (gegenhalten, resistance) with frontal lesions of different nature (metabolic encephalopathy, diffuse cerebral atrophy, vascular encephalopathy with arterial hypertension), plastic increase in muscle tone (parkinsonism, progressive supranuclear palsy, other dystonic syndromes, stiffness), catalepsy with schizophrenia, diseases of the cervical spine or vertebrogenic muscular-tonic syndromes. Difficulty in straightening the head in these conditions is observed in the context of other significant neurological, somatic and mental disorders that must be taken into account when interpreting this symptom.

For differential diagnosis between inflammatory lesions meninges and meningism requires research cerebrospinal fluid obtained by spinal puncture.

Additional methods include fundus examination, skull radiography, echoencephalography (for children under one year of age - sonography), EEG, CT and MRI of the brain. If a patient has meningeal syndrome, the following algorithm of actions is advisable.

– 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 the results of cerebrospinal fluid examination. Treatment is carried out according to the etiology with antibacterial, antiviral, antifungal, antiprotozoal agents, including symptomatic therapy, decrease in intracranial pressure.

General information

Meningeal (meningeal) syndrome is a common pathology encountered by neurologists, infectious disease specialists, pediatricians, therapists, otolaryngologists and many other specialists. The syndrome gets its name from the Latin term “meningea,” which refers to the membranes of the brain. In cases where meningeal syndrome is caused by irritation of the cerebral membranes without their inflammatory changes, in medical practice The definition used is meningism. Peak active learning pathology occurred at the end of the 19th century, by various authors numerous specific symptoms diseases used today. Meningeal syndrome is observed at any age without gender preference. In elderly patients there is erased clinical picture.

Causes of meningeal syndrome

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

Inflammatory lesions:

Bacterial. Nonspecific – conditional meningococcal infection, Haemophilus influenzae, streptococci, pneumococci, in newborns - salmonella, E. coli. Specific - occurring when pathogens of tuberculosis and syphilis penetrate the membranes.
Viral. In 75% of cases they are provoked by enteroviruses, less often - Epstein-Barr virus, arenavirus, herpes infection, tick-borne encephalitis virus.
Fungal. The main pathogens are cryptococci, candida, aspergillus, histoplasma. They cause serous inflammation of the membranes with petechial hemorrhages.
Protozoans. Observed in toxoplasmosis, malaria.

Non-inflammatory lesions:

Hemorrhages in the membranes of the brain. May arise due to acute disorder cerebral circulation, severe arterial hypertension, head injury, cerebral vasculitis.
Intracranial hypertension. Develops due to hydrocephalus, volumetric formations(brain tumor, intracranial cyst, abscess, intracerebral hematoma).
Intoxication. Exogenous – paint and varnish production, substance abuse, alcoholism. Endogenous – uremia, hypoparathyroidism.
Neurotoxicosis for general infectious diseases (influenza, typhus, dysentery, ARVI).
Carcinomatosis– infiltration of the cerebral membranes tumor cells for various oncological processes, including leukocyte infiltration in neuroleukemia.

Pathogenesis

Meningeal syndrome has two development mechanisms. The first, the inflammatory process, occurs in response to the penetration of infectious agents. Infection of the cerebral membranes occurs through contact (with open head injury, osteomyelitis of the skull bones), lymphogenous, perineural, and hematogenous routes. The introduction of pathogens through the bloodstream is more often observed in the presence of foci purulent infection(sinusitis, purulent otitis, mastoiditis). With encephalitis, inflammation in the brain substance spreads to the tissues of the membranes with the development of meningoencephalitis. Second pathogenetic mechanism– irritation of the meninges. An irritating effect is caused by blood accumulations during subarachnoid hemorrhage, increased intracranial pressure, toxic substances, entering the body from the outside or formed as a result of dismetabolic processes, the activity of pathogenic microorganisms, tissue decay during oncological diseases.

Symptoms of meningeal syndrome

The meningeal symptom complex is formed by general cerebral manifestations and the meningeal symptoms. Intense diffuse cephalalgia (headache), vomiting without preceding nausea is typical. Vomiting is not accompanied by relief general condition sick. In severe cases, agitation is observed, followed by apathy, possible epileptic seizures, hallucinations, depression of consciousness to the point of stupor, coma. The pathognomonic symptoms that characterize meningeal syndrome include three groups of symptoms: signs of hyperesthesia, muscle-tonic manifestations, and pain phenomena.

Hyperesthesia is manifested by increased sensitivity to sounds (hyperacusis), light (photophobia), and touch. The most common muscle-tonic symptom is rigidity (hypertonicity) occipital muscles, detected when attempting to passively flex the patient’s head. An increase in muscle tone causes a typical position: lying on your side with an arched back, head thrown back, limbs bent and brought towards the body (“pointing dog pose”). Reactive algic symptoms include eye pain with movement and pressure on the eyelids, pain at trigger points trigeminal nerve, Kehrer points on the back of the head, in the cheekbone area.

Diagnostics

Meningeal syndrome is diagnosed by specialists in the field of infectology, pediatrics, neurology, and therapy. When examining, pay attention to the presence of meningeal posture, hyperesthesia, pain and tonic phenomena. Hypertonicity of meningeal origin is differentiated from muscle tension accompanying myositis, radiculitis. IN neurological status determine characteristic changes reflex sphere: revival of reflexes, followed by their uneven decrease. If meningeal syndrome is associated with damage to the brain substance, then a corresponding focal neurological deficit is detected (pyramidal insufficiency, aphasia, cerebellar ataxia, facial nerve paresis). There are more than 30 clinical symptoms, helping to diagnose meningeal syndrome. The following are most widely used among neurologists and general practitioners:

Kernig's sign– with the patient lying on his back, passively bend the lower limb at 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 shin flexor muscles.
Brudzinski's symptoms– in the supine position there is an involuntary pull-up lower limbs to the abdomen when bending the patient’s head (upper), pressing on the pubis (middle), checking Kernig’s sign (lower).
Edelman's sign– extension of the big toe when examined using the Kernig method.
Netter's sign– in a sitting position with legs extended in bed, pressing on the knee of one leg causes the other to bend.
Cholodenko's symptom– bending of the knees when the doctor tries to lift the patient by the shoulders.
Guillain's sign– with the patient lying on his back with his legs straightened, compression of the muscles of the anterior surface of one thigh leads to flexion of the second leg.
Lessage's sign– when holding a child in the air in vertical position The legs are pulled up to the stomach by the armpits. Characteristic for young children.

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

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

Treatment of meningeal syndrome

Developed 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 is stopped 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 illness Central nervous system, fulminant course of the 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.

Meningism is clinical syndrome, which is characterized by irritation of the membranes of the brain. This syndrome is often confused with meningitis, but it is not the same thing. Symptoms are more pronounced than with meningism.

The term “meningism” was first introduced into scientific use by Dr. Dupre; this syndrome is often observed in young children suffering from fever, less often in adults.

Provoking factors

The brain in the human body is usually quite well protected by immune system. But if the patient’s immunity is weakened, and pathogenic bacteria still penetrate the brain, then it is natural that the body begins to resist the infection. By doing this, he only aggravates the situation.

White and red blood cells, which are produced in abundance, penetrate into areas of the brain. This causes inflammation, and then... If the situation continues to develop, blood and oxygen will stop flowing to the brain. In addition, the current infectious disease will only get worse.

What reasons can cause meningism:

Characteristic manifestations

Symptoms and manifestations of meningism appear very quickly, and qualified specialist It won’t be difficult to recognize them:

Making a diagnosis

To begin with, carry out visual inspection patient, and already at this level it is possible to identify symptoms such as fever, rapid heartbeat, changes in the psyche.

The most crucial moment in making a diagnosis is a lumbar puncture. This procedure is performed to obtain cerebrospinal fluid, which is sent to the laboratory for further testing.

Other procedures may be performed at the discretion of the doctor.

Medical assistance

When it comes to treating this syndrome, there is no need to hesitate; treatment of meningism must be carried out quickly, competently and promptly. Treatment of this syndrome is carried out in a hospital and is aimed at reducing the pressure inside the skull.

Most often this drug therapy, and also intramuscular injection liquid that can relieve cerebral edema.

In order to prescribe medications, the doctor must know what exactly caused the meningism. So in the case bacterial origin infection, the patient is prescribed antibiotics of the widest spectrum; if the infection is caused by a virus, then antiviral drugs.

Other drugs prescribed to the patient are intended to reduce body temperature, relieve pain, reduce shock syndrome and convulsions.

In the event that the patient cannot take the medicine on his own, the drugs are injected directly into the spinal canal.

If meningism is not recognized in time and treated, it will develop into a more serious and significant disease - which is very often accompanied by complete epileptic seizures and other neurological problems.

Important to know! The consequences and complications of meningism may not manifest themselves immediately, but only years later.

For prevention purposes

Compliance with the following rules will help protect against meningism, and in the future:

It is important to know: some people prefer to protect themselves from meningitis and meningism with vaccinations, however, this is not the right way out of the situation. These diseases have many pathogens, and it is impossible to protect against them all with just one vaccination.

Thus, meningism is a very insidious syndrome that can cause a lot of health problems to its owner. To prevent this from happening, you need to carefully follow preventive measures and consult a doctor on time.

– an infectious-inflammatory process affecting the meninges. The course of meningitis in children is accompanied by general infectious (hyperthermia), cerebral (headache, vomiting, convulsions, impaired consciousness) and meningeal syndrome (stiff neck, general hyperesthesia, meningeal posture, positive symptoms of Kernig, Lessage, Brudzinsky, bulging of the large fontanelle). Diagnosis of meningitis in children requires lumbar puncture, studies of cerebrospinal fluid and blood. The basic principles of treatment of meningitis in children are: hospitalization of the child, bed rest, antibacterial/antiviral, detoxification, dehydration therapy.

General information

At proper treatment meningitis in children, in the phase of reverse development, resorption of inflammatory exudate occurs, normalization of liquor production and intracranial pressure. In case of irrational treatment of meningitis in children, organization may occur. purulent exudate and the formation of fibrosis, which will result in a violation of liquor dynamics with the development of hydrocephalus.

Classification of meningitis in children

Primary meningitis in children occurs without previous local inflammatory process or infections; Secondary meningitis in children develops against the background of the underlying disease and acts as a complication.

Taking into account the depth of the lesion in the structure of meningitis in children, they distinguish: panmeningitis - inflammation of all meninges; pachymeningitis – predominant inflammation of the dura mater; Leptomeningitis is a combined inflammation of the arachnoid and pia mater. Separately, arachnoiditis is isolated - an isolated lesion arachnoid membrane, which has its own clinical characteristics.

According to the severity of intoxication and cerebral syndrome, as well as inflammatory changes in the cerebrospinal fluid, they distinguish between mild, moderate and severe form meningitis in children. The course of neuroinfection can be fulminant, acute, subacute and chronic.

Etiologically, according to the pathogen, meningitis in children is divided into viral, bacterial, fungal, rickettsial, spirochetal, helminthic, protozoal and mixed. Depending on the nature of the cerebrospinal fluid, meningitis in children can be serous, hemorrhagic and purulent. The structure of pathology in pediatrics is dominated by serous viral and bacterial (meningococcal, hemophilic, pneumococcal) meningitis in children.

Symptoms of meningitis in children

Regardless of the etiology, the course of meningitis in children is accompanied by general infectious, cerebral, meningeal symptoms, as well as typical inflammatory changes in the cerebrospinal fluid.

General infectious symptoms of meningitis in children are characterized by a sharp increase in temperature, chills, tachypnea and tachycardia, and the child’s refusal to eat and drink. There may be pallor or hyperemia of the skin, hemorrhagic rash on the skin associated with bacterial embolism or toxic paresis small vessels. Separate nonspecific symptoms occur in certain forms of meningitis in children: acute adrenal insufficiency - with meningococcal, respiratory failure - with pneumococcal, severe diarrhea - with enterovirus infection.

The cerebral syndrome that accompanies the course of meningitis in children is characterized by intense headaches associated with both toxic and mechanical irritation of the meninges. Headache can be diffuse, bursting, or localized in the frontotemporal or occipital region. Due to reflex or direct irritation of the receptors of the vomiting center in the medulla oblongata, repeated vomiting occurs, not associated with food intake and not bringing relief. Impaired consciousness during meningitis in children can be expressed in doubt, psychomotor agitation, development soporous state or coma. Often, with meningitis, children experience convulsions, the severity of which can vary from twitching of individual muscles to a generalized seizure. It is possible to develop focal symptoms in the form of oculomotor disorders, hemiparesis, and hyperkinesis.

The most common form of meningitis in children is meningeal syndrome. The child lies on his side, with his head thrown back; arms bent at the elbows and legs bent in hip joints(“cocked hammer pose”). There is increased sensitivity to various irritants: hyperesthesia, blepharospasm, hyperacusis. A characteristic feature Nuchal rigidity (inability to press the child’s chin to the chest due to tension in the neck muscles) is the cause. Due to increased intracranial pressure in infants there is tension and bulging of the large fontanel, a pronounced venous network on the head and eyelids; When the skull is percussed, the sound of a “ripe watermelon” appears. The membrane signs characteristic of meningitis in children include Kernig's, Brudzinski's, Lessage's, Mondonesi's, and Bechterew's symptoms.

Suspicion of meningitis in children is an indication for performing a lumbar puncture and obtaining cerebrospinal fluid for biochemical, bacteriological/virological and cytological examination. The results of the study of cerebrospinal fluid make it possible to differentiate meningism and meningitis, and to determine the etiology of serous or purulent meningitis in children.

By using serological methods(RNGA, RIF, RSK, ELISA) the presence and increase of specific antibodies in the blood serum is detected. PCR testing of cerebrospinal fluid and blood for the presence of pathogen DNA is promising. As part of the diagnostic search, bacteriological cultures blood and nasopharyngeal secretions into selective nutrient media.

Etiotropic therapy of meningitis in children involves intramuscular or intravenous administration antibacterial drugs: penicillins, cephalosporins, aminoglycosides, carbapenems. At severe course meningitis in children, antibiotics can be administered endolumbarally. Until the etiology is established, the antibiotic is prescribed empirically; after receiving the results laboratory diagnostics therapy is adjusted. The duration of antibiotic therapy for meningitis in children is at least 10-14 days.

After establishing the etiology of meningitis in children, antimeningococcal gamma globulin or plasma, antistaphylococcal plasma or gamma globulin, etc. can be administered. viral meningitis in children it is carried out antiviral therapy acyclovir, recombinant interferons, inducers of endogenous interferon, immunomodulators.

The pathogenetic approach to the treatment of meningitis in children includes detoxification (administration of glucose-salt and colloid solutions, albumin, plasma), dehydration (furosemide, mannitol), anticonvulsant therapy(GHB, sodium thiopental, phenobarbital). To prevent cerebral ischemia, they are used nootropic drugs and neurometabolites.

Ultrasonography).

Among the measures aimed at reducing the incidence of meningitis, the main role belongs to vaccine prevention. When identifying a child with meningitis in children's institution, quarantine measures are carried out, biological examination is carried out contact persons, administration of specific gamma globulin or vaccine. Nonspecific prevention of meningitis in children consists of timely and complete treatment infections, hardening children, teaching them to observe personal hygiene standards and drinking regime(washing hands, drinking boiled water etc.).