Pachymeningitis (pachimeningitis; from the Greek. pachys - dense and meninx, meningos - mater - is an inflammation of the Dura mater. There are pachymeningitis external, internal and vnutripolostny. Pachymeningitis may be localized in the shell of (pachimeningitis cerebralis) or spinal cord (pachimeningitis spinalis.
Cerebral pachymeningitis. Cerebral P. may be purulent, serous or hemorrhagic. Purulent P. observed more often and usually occurs by switching infection with the skull bones or soft tissues. The cause of purulent P. - purulent otitis media with carious process in the bones or cholesteatoma, purulent inflammation of the paranasal bones of the nose (frontal sinus, ethmoid with carious process in them), injury to the skull, followed by suppuration; less purulent processes soft tissues of the head (carbuncle, a cellulitis). Purulent cerebral pachymeningitis usually limited, forming of extra - and an intradural abscesses. The transition of the inflammatory process on the walls of the veins and sinuses leads to the development of phlebitis and sinus phlebitis with subsequent thrombosis them. The most frequently observed thrombosis transverse and sigmoid sinus, rarely cavernous. Promotion of infection through the veins can lead to the defeat of soft shells, the development of brain abscesses, sometimes to sepsis.
The main symptom of purulent cerebral pachymeningitis is a headache, it is most intensive at large abscesses and localize them in the posterior cranial fossa. Pain increases with percussion skull according to defeat shell. When subdural abscesses are identified local symptoms: neuralgic pain in the branches of the trigeminal nerve, a symptom of Gradenigo, nystagmus, dizziness. Usually there are apathy, drowsiness, various degree of clouded, sometimes delusional state. The pressure of the cerebrospinal fluid is increased. The composition of it or normal, or there is excessive protein content, the appearance of considerable pleocytosis indicates the transition process in soft shell. Thrombosis sigmoid and transverse sinus is diagnosed on the basis of a lack increase the pressure of the spinal fluid when compressed jugular vein on the affected side.
The outcome extradural of pachymeningitis more favorable. Sometimes there is a cure itself, after which the shell remains fibrous thickening. Subdural abscesses less favourable due to the possibility of spread of the infection soft shell and the substance of the brain.
There are several approaches in combination with antibiotics.
Nagnoenie, serous, forms of cerebral P. rare. It is possible that they arise in General infection and intoxication and allergic reactions. Such cases are asymptomatic or accompanied by transient headache and go undiagnosed.
Hemorrhagic pachymeningitis. The reasons leading to dural hemorrhage,- a head injury, sometimes very small, high blood pressure, atherosclerosis age and is caused by chronic infections, decompensated heart disease, blood diseases (malignant anemia, leukemia), bloody diates, chronic increased intracranial pressure (brain tumor, hydrocephaly) and acute (cough tremors, acute swelling of the brain). Small dural hemorrhage asymptomatic, but when they are incurred accompanied by a feeling of pain shot in the head according to hemorrhage. With extensive hemorrhage, mainly subdural, after a painful blow headache becomes spilled, accompanied by vomiting and sometimes loss of consciousness. In this case, there fatigue, mental confusion, memory loss; sometimes there are attacks mental anxiety, delirium. Focal symptoms depend on the localization process. These include: seizures Jacksonian type, Hemi - or monoparty spastic nature, disorders of the statics, dizziness, aphasia, less frequent eye disorders; congestive nipples with bleeding in the retina or neuroticeski changes nipple optic nerve. When significant hematoma observed meningeal symptoms, but not in sharp degree. The pressure of the cerebrospinal fluid is increased, the composition of it or normal, or there is an increased amount of protein (sometimes with slight xanthochromia) and moderate pleoticus.
The development of acute or progressive, passing in severe cases coma with impaired respiration, pulse, areflexia. The temperature in the initial period subfebrile, in the future, with the development of complications (pneumonia) high. The disease or increasing (death), or remitting. In the latter cases it is possible recovery.
Treatment with extensive bruising surgery. When remitting and mild cases - conservative therapy. You must treat the underlying disease. Apply symptomatic funds: infusion of calcium chloride (Sol. Calcii chlorati a 10% 10,0 10 ml intravenously), menadione (Vicasoli 0.01 g 1 tab. 2 times a day; treatment for 3-4 days, then 4 days break, then 3-4 days), rutin (Rutini 0.02 g in table 2. 2 times a day; treated 4-6 weeks + ascorbic acid 0.05 g per day).
Spinal pachymeningitis. Localization of the inflammatory process distinguish pachymeningitis exterior and interior, the latter is rare. Outer P. transition is always accompanied by inflammation on epidural fiber; with an initial localization of process in epidural fat, it can spread to the outer surface of the shell. In that and in other case, in essence, has to say about peripheriegergte, or pidurite (see).
Hyperplastic forms of P. treat chronically current P. Morphologically they are characterized by the development of granulation tissue, solitary granulomas, the growth of fibrous tissue in the shell, which leads to the formation of adhesions and binding. Localized these processes or in the epidural space, or in a rigid sheath. As a result of these processes is squeezing hard shell and spinal cord.
Etiological moments are tuberculosis and syphilis. Localization of TB pachymeningitis - most of the thoracic region, syphilis - neck. The clinical picture after the previous stage of radicular symptoms gradually revealed signs of compression of the spinal cord with the development of spastic paraparesis or tetraparesis and conductive disorders of sensitivity. Rarely defeat is one-sided, giving syndrome brown-séquard (see the brown-séquard syndrome).
The differential diagnosis should be performed with tumors of the spinal cord, arachnoiditis. In the diagnosis of great importance radiography of spine and setting specific reactions in the blood and cerebrospinal fluid.
Treatment - specific when syphilis in residual States mud baths, hydrogen-sulphidous baths, therapeutic physical exercise; in tuberculous P. apply special treatment.