Meningeal syndrome

When any form of acute meningitis are the symptoms of cerebral and local United in meningeal syndrome. In meningeal syndrome include changes in the spinal fluid. Headache is the main and principal symptom of meningitis; it is particularly strong in tuberculous meningitis. Headaches are often diffuse in nature, but often sick localize them in the forehead, temples, neck. The second cardinal symptom M is vomiting. Temperature Meters are usually raised. At purulent meningitis it reaches 40 degrees and higher viral and M. tuberculosis is usually low grade.
Often at the monastery there are contractures limbs that are amenable to correction. Early symptom of meningitis is the rigidity of muscles of the head: the head is sick thrown back, head movement difficult. Also typical symptoms of Cernica and Brudzinskogo - top and bottom, or contralateral. Symptom of Cernica is impossible to straighten the knee when she bent at the hip. Top symptom Brudzinskogo - passive bending patient's head to her breast is involuntary leg curl in the hip and knee joints. Lower symptom Brudzinskogo - passive bend one leg at the hip and extension in the knee patient is involuntarily bends the other leg. In children of early age, there is also a symptom hanging Lesage: if you raise, holding under the arms, a child suffering from meningitis, he bends his legs at the knee and hip joints and fixes them in that position; healthy child with this sample free Flex and unbends legs.
From the musculoskeletal manifestations of irritation with meningitis marked cramps and seizures epileptiformnye, especially in children. Less frequent are the motor of the phenomenon of precipitation in the form of paresis and paralysis. Much more often there are disorders functions of craniocerebral nerves, especially the eye that appears to amblyopia, strabismus and ptosis; these eye disorder most commonly found in TB and syphilis M also Often marked facial paralysis, change of vision and hearing.
For acute M. common hyperesthesia skin at the height of meningeal process. Very painful for the patients of giperestesia senses: noise, sharp light, loud conversation annoying patients. The involvement of the roots of the spinal cord causes radicular pain and giperestesia early in the disease and anesthesia in a later period; for the same reason tendon reflexes can be first raised, and then gradually reduced. Belly reflexes usually reduced. In acute meningitis can meet pathological reflexes Babinski and Oppenheim.
Vegetative disorders accompanied by acute M. on the duration of the illness. Marked arrhythmia of the heart, the dissociation between the pulse and temperature. Broken rhythm and depth of breathing, in severe cases develop Cheyne-Toksovo breath. There anisocoria and violation pupillary reaction to light, accommodation and convergence. In acute Meters, especially in children, there is a skin rash on the chest, abdomen and extremities. Often there herpes, especially on the lips. Noteworthy lability of vasomotor: in response to the pressing or touching the skin appear red and white patches, sick then red, then fades (spot trusso). Pelvic disorders are not typical for meningitis; only in severe cases, there incontinence of urine and feces; in children of early age at onset, there is diarrhea, and later constipation. Mental disorders in acute M. constant.
For meningeal syndrome is characterized by changes in the cerebrospinal fluid; on the basis of her research will ultimately be set not only the diagnosis of acute Meters, but define its shape, which is important for prognosis and treatment. The pressure of the cerebrospinal fluid for acute meningitis increased; the liquid in some cases muddy (purulent M), in others only opalestiruty (M. tuberculosis), in the third transparent (serous M). In some forms of acute Meters (tuberculosis, acute lymphocytic) in liquid when standing is formed film.
Pleoticus in the spinal fluid is especially characteristic of M. acute purulent M, it reaches 2000-3000 1 mm3 and above first polinucleari, and then lymphocytes; with M. tuberculosis, Placitas varies from almost normal figures of up to 100-300 (Doctor S. Footer) - 800 (D. A. Shaburov) in 1 mm3; cell - mostly lymphocytes. When serous M Placitas, mainly lymphocytic, subject to large fluctuations-from 50 up to 1500 1 mm3 (D. A. Shaburov). The amount of protein in acute meningitis is also increasing, with serous M-from 0,4 to 1,0 PPT. Globulin reaction (Pandi and Nonna - apelt reaction) sharply positive in introducing and M. tuberculosis, less dramatically when serous M currently applies the method of electrophoresis of proteins in the blood and cerebrospinal fluid, which gives a more accurate view of the albumin and about individual globulin fractions.
The content of sugar and chlorides in the spinal fluid is reduced especially at tuberculous meningitis, less sharply in introducing M Colloidal reactions in almost all forms of flour give meningeal the type of curve. Often in liquid detected pathogens (meningococci, TB bacilli and other). There are also identified the virus lymphocytic choriomeningitis.
The nature of meningeal syndrome can vary depending on the localization process. With the localization process mainly on the convex surface of the cerebral hemispheres is dominated phenomenon irritation in the form cramps and seizures )! further develop the paresis and paralysis; preferential localization process on the base of the brain early amazed craniocerebral nerves, causing reduction of vision and hearing, ptosis, strabismus, and with the involvement of the bottom of the third ventricle may be hypothalamic disorders.
Mg occurs more often in children than in adults. A separate clinical forms Meters, such as subacute form of epidemic M, are more common in infants and young children. The old people meningeal syndrome is reduced. In the pathogenesis of meningeal syndrome is set to a number of factors. The inflammatory process affects receptors and vessels soft meninges; in all forms M. develops hypersecretion of cerebrospinal fluid and damage perineurally spaces and pahinui granulation decrease absorption and drain fluid. All this leads to the formation of brain edema, increased intracranial pressure, causing headache, vomiting, changes in the fundus, cochlear neuritis and disorders of the higher nervous activity.
With the involvement of the brain during acute M. complicated. Convulsions, seizures, hemiparesis are the result of irritation and oppression of the crust and cortex. The defeat of the trunk raises a number tonic and labyrinth reflexes, and bulbar disorders. Giperestesia result of irritation of the posterior roots of spinal and cranial nerves.