What are meningeal signs. Cerebral signs of meningitis

Meningeal symptoms can be a sign of the development of a serious disease - meningitis. More often it affects patients childhood and male representatives. The article analyzes the main meningeal manifestations, using which you can distinguish a common headache from a dangerous disease.

Meningeal syndrome is manifested by headache, hypersensitivity of the skin, in addition, a patient with such syndrome tend to be in a specific meningeal position: lying on your side, tilting your head back, pressing your hands to your chest, pulling your legs to your stomach.

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

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

Technique for checking for symptoms

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

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

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

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

With a positive meningeal symptom, the subject cannot perform the second part of the study due to the high tone of the flexor muscles of the leg.

The next meningeal sign is the Brudzinsky symptom, which was described by a pediatrician. There are 4 types: buccal, upper, middle and lower. The first is determined by pressing the cheek under the cheekbone, while the shoulder girdle moves up, and the arm bends at the elbow. The second, that is upper symptom, is characterized by bending the legs with pressing to the stomach while trying to bring the patient's head to the chest.

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

One of the meningeal symptoms was described by a French neurologist, the symptom is named after Guillain. The bottom line is to press on the thigh in front, while there is a reflex flexion of the other leg in the hip and knee joints.

Significant and common is Bechterew's symptom, known as "zygomatic". It is characterized by an increase in headache and a painful grimace (due to tonic tension in the muscles of the face) when tapping on the zygomatic bone. The reaction of the muscles is observed from the produced percussion.

Features of determining changes in pediatric patients

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

"landings"- when trying to seat a child with straight legs, he bends them or leans his body back with support on his hands;

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

"knee kiss" characterized by the inability to touch the mouth to the knees in a sitting position.

In addition, in patients of early childhood there is a bulging of a large fontanel.

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

Lafora- sharpening of facial features;
Bikkel- long-term presence of the patient with bent arms;

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

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

Comprehensive diagnostics

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

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

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

Meningeal signs are varied. As a rule, when making a diagnosis, verification of each of the listed manifestations is optional. It is considered sufficient to determine the main features. The detected meningeal symptom complex requires laboratory research to confirm the diagnosis.

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

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

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

Meningococcus is able to enter various tissues or organs human body, but most often it penetrates the brain, where it develops inflammatory process soft meninges.

Start

The disease begins most often with a simple chill and an increase in body temperature to 37-40 degrees. In 45% of patients, nasopharyngitis appears in the next week. The doctor makes the initial diagnosis of ARI. Further developed:

Severe headaches and, as a result, intoxication. intracranial hypertension.
Weakness, fatigue.
Vomiting without nausea, without relief.
Sensitivity to stimuli (light, sound, etc.).

First day

The first day of the course of the disease may have such meningeal symptoms as irritation of the meninges, rapidly increasing. There are four main signs representing meningeal symptoms:

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

Rash

A sign in the form of a rash - small bruises, rapidly increasing in diameter and number against the background high temperature is an indication of meningitis. Symptoms point to very serious illness, life threatening person. Call an ambulance immediately!

Meningeal symptoms: description

Kernig's sign

It was described by our Russian therapist V. M. Kernig. The bottom line is that the patient is unable to passively unbend the legs, previously bent at the knee and hip joint at a right angle. It is worth knowing that newborns have Kernig's syndrome as a physiological fact, it disappears at about three months of age.

Symptom Brudzinsky

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

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

Meningeal syndrome - Guillain's symptom

The patient pulls the leg to the stomach, if you slightly squeeze the quadriceps muscle or pinch the skin above it.

Meningeal symptoms of Gordon

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

Herman's symptom

Passive neck flexion provokes extension thumbs legs.

Symptom of the Soviet neuropathologist Kuimov

Light pressure on the eyes provokes a pain mimic reaction.

Bechterew's symptom

Tapping on the zygomatic bone increases the headache and is accompanied by tonic contraction of the facial muscles. There is a grimace of pain, usually on the same side of the face. The neglected disease is characterized by the meningeal posture of the "pointing dog". The patient lies on his side with his knees bent and his head thrown back.

Meningeal symptoms at purulent inflammation a lot of meninges have been described. These include neck stiffness, Kernig's sign, various options Brudzinsky's symptom (upper, lower, buccal, pubic), Gillen's symptom. In addition, meningitis has whole line pathological reflexes described by Babinsky, Oppenheim, Rossolimo, Gordon, Bekhterev and others.

to the most important symptoms meningitis refers primarily to neck stiffness and Kernig's symptom. The appearance of these signs is due to reflex muscle contraction, which protects nerve roots(cervical and lumbar) from sprain. These symptoms are also observed when the meninges are irritated by any pathological process located in the cranial cavity, such as an abscess of the brain, cerebellum, and others. The severity of individual shell signs depends in such cases on the localization of the abscess and the reaction of the meninges. The study of meningeal symptoms is usually performed with the patient in the supine position.

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

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

Brudzinsky, as already said, many symptoms have been suggested. However, with inflammation of the meninges, they are content with studying only two of them: the “upper” and “lower”. The first is revealed in the study of the rigidity of the muscles of the neck, namely, with a passive tilt of the head forward. At this time, automatic bending occurs lower extremities in the hip and knee joints and pulling them to the stomach.

Gillen's sign is caused by squeezing the hand of the examiner of the quadriceps muscle, which, as you know, occupies the entire anterior and partly side surface hips. In response to the compression of the mentioned muscle, a contraction of the muscle of the same name on the other leg occurs.

To the signs inflammation meninges, indicating a sharp increase in irritation of the sensitive sphere, include the symptoms described by Külsnkampf and Knik. Kühlenkampf described two features. One of them is that with a strong bending of the knee to the stomach, pain occurs that radiates to the sacrum. The second is pain with pressure on the atlantooccipital membrane. We add on our own that with meningitis, pain is also often noted during palpation of the spinous processes of the cervical vertebrae. Knick's symptom is that pressure on the area behind the corner mandible causes pain.
It must be emphasized that any manipulation on patients suffering from otogenic meningitis, regardless of their nature and intensity, cause discomfort and the corresponding response.

Pathological reflexes triggered on injury nervous system, namely pyramidal path. They are detected with appropriate studies on the foot; on the hands, pathological reflexes are rarely observed and therefore do not have practical value. The main ones are the symptoms of Babinsky, Rossolimo, Oppenheim, Bekhterev and Gordon. These reflections have highest value in clinical practice. In the clinical picture of the disease, all pathological reflexes are sometimes observed, or only part of them, most often the symptoms of Babinsky, Rossolimo and Oppenheim.

Separate forms of pathological reflexes or a different combination of them are observed in severe cases of otogenic meningitis. Therefore, they are of particular importance in the neurological examination of such patients.
We will focus briefly on the method of identifying pathological reflexes. The starting position for their study is the position of the patient on his back.

Video definition of meningeal symptoms

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

Meningitis is a demyelinating disease of the nervous system that leads to the destruction of the myelin sheath of neurons. Treatment at home is prohibited. It is important to identify symptoms early and get urgent medical care. The complexity of diagnosing is in the identity of the signs of the disease with the flu. A common form of the disease is bacterial meningitis. It does not destroy the body, but weakens it. Upon detection the following symptoms, see a doctor immediately.

What are the meningeal signs and symptoms

The disease occurs in two forms: viral and bacterial. Depending on the type, patients show characteristics. To 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;
violation of the rhythm of breathing, increased heart rate;
blood clots may appear.

Meningeal symptoms in children are as follows:

strong headache radiating to the neck, back;
vomiting against the background of unbearable headaches;
hypersensitivity to touch;
convulsions, hyperesthesia;
the posture of the pointing dog 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 in each patient is individual. The main and often manifested irritations of the meninges are considered stiff neck, a symptom of Kernig. Incubation period illness is 2-10 days. The disease is accompanied by accompanying signals that often mislead doctors. Diagnosis is carried out during the hospitalization of the patient. Treatment includes tonic measures aimed at strengthening the body.

Romberg pose test

A simple diagnostic test - Romberg's test - reveals impaired performance of organ systems that are involved in maintaining balance. These include: vestibular apparatus, proprioception system (deep sensitivity), brain functions cerebral cortex. Conduct: the patient stands up straight, moving his legs, with eyes closed stretches his arms forward. Swinging, swinging to the right or left, etc. indicate damage to the cerebellum, neurological abnormalities.

Kernig's sign

One of important features violations of the meninges of the membrane - a symptom of Kernig. Named after the Russian therapist Kernig V.M. Method of carrying out: the patient, lying on his back, bends the leg at the joints by 90 degrees. Next, the doctor tries to straighten the leg. With meningitis, this cannot be done. The analysis is equally positive on both sides of the conduction. Occurs on early stages development of meningitis.

Babinski reflex and asynergy

Babinsky's asynergy is being carried out in the following way: the patient, lying on his back, crosses his arms and offers to sit down. On the side of the lesion, the patient's lower limbs rise. Another interpretation: when pushing back or falling, the patient falls back with damage to the cerebellum. There is no flexion of the knee joints to maintain balance. Asynergy - indicates the difficulty of conducting combined movements. Happens on initial stage development of meningitis and other diseases.

Symptom Brudzinsky

The combination of signs formed due to brain damage is a symptom of Brudzinsky. Occurs immediately with several diseases. There are the following types:

Upper. It manifests itself as involuntary bending of the legs, pulling up to the stomach when hanging (lowering) the head down.
Average. With pressure on the pubis, the legs bend.
Lower. When checking, a symptom of Kerning is revealed on the one hand, on the other hand, the leg, bending, is pulled up to the stomach.
Cheek. When you press the zygomatic arch, the shoulders rise, the arms bend.

Muscle stiffness

Appears in almost 80% of cases. Indicates irritation of the membranes of the brain, disorders of the central nervous system. Rigidity of the occipital muscles is determined in the patient in the supine position. With passive flexion of the head, tension occurs in the muscles of the neck and occipital. They prevent bringing the chin to the chest. Muscle rigidity cervical often accompanied by tightness of the muscles of the back and limbs. False rigidity also occurs in the presence of spondylarthrosis, spondylosis of the cervical spine.

Symptom Rossolimo

The finger reflex is caused by the blows of fingers on the phalanges of 2-5 toes of the patient's foot. The patient's reaction is to flex the sole or to rare cases their withdrawal. The patient is examined in the supine position. All fingers or 2 and 5, one big one can participate in the movement. Healthy individuals have no symptoms. The symptom refers to the pathological flexion type, manifested when the pyramidal tract is damaged. The second option: the definition of a symptom is carried out on the hands of the patient.

Symptom of Oppenheim

During the analysis, extension of the big toe is observed during irritation of the medial surface of the lower leg. Methodology: phalanx of a large or index finger the doctor with force carries out sliding movements from top to bottom along the medial surface of the lower leg. Flexion of the fingers is considered normal. With meningitis, extension of the fingers occurs with a slight turn of the foot. Oppenheim's symptom is similar to Babinski's reflex. The reflex occurs in most lesions of cerebral activity.

Video about meningeal symptoms

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

Kernig's symptomatology is typical not only for children and patients who develop meningitis, but also for people with problems in the knee joints. Kernig's meningeal syndrome allows you to establish accurate diagnosis in children and adults. essence this syndrome consists in the fact that during flexion and extension of the knee, hip joint(with the help of a doctor) there is no full extension of the leg. This meningeal syndrome is being investigated in 2 stages.

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

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

Other options

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

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

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

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

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

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

These signs were introduced into practice by the Polish doctor Josef Brudzinsky. Since the beginning of the 20th century, they have been standard in diagnosing.

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

The next symptom is the lying dog posture. In severe lesions of the nervous system, the work of the whole organism is disrupted.

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

Opisthotonus, trismus of chewing muscles

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

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

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