General principles of early diagnosis. Meningism - symptoms and treatment, photos and videos

Meningism - main symptoms:

• Headache
• Skin rashes
• Convulsions
• Nausea
• Vomit
• Chills
• Confusion
• Rapid pulse
• Memory loss
• Decreased arterial pressure
• Fever
• Photophobia
• Impaired concentration
• Anxiety
• Refusal to eat
• Breathing problems
• Restricted neck mobility
• Thirst
• Inability to straighten the leg
• Pallor of the nasolabial triangle

Meningism is a syndrome that manifests itself in infectious diseases, poisoning and traumatic brain injuries. It is characterized by irritation of the membranes of the brain. Some people confuse the problem with meningitis, but in their clinical pictures there is a difference. The symptoms of meningitis appear clearly and quite clearly.

• Etiology
• Symptoms
• Diagnostics
• Treatment
• Possible complications
• Prevention

Most often, meningism occurs in children with fever, in rare cases it is diagnosed in adults. According to ICD-10, meningism is coded R29.1.

Causes of the disease

The human immune system protects the brain very well. But if it happens that with a weak immune system, the infection still gets there, the body still tries to fight it. Paradoxically, this only makes the situation worse.

Due to the fact that at this time red and white cells begin to be produced in excess and enter the brain, inflammatory processes which may result in swelling. If nothing is done, the access of blood and oxygen to the brain will be blocked. Further development infectious disease will get worse.

Clinicians highlight following reasons meningism:

Infantile meningism syndrome can even occur due to high pressure.

and meningism

Symptoms of the disease

All signs indicating meningism occur quickly, so it will not be difficult for the doctor to recognize them.

Symptoms of developing meningism:

• a sick child has chills that turn into fever;
• mental disorders: confusion, sometimes mental disorders appear;
• nausea, sometimes with severe vomiting;
• Photophobia occurs - in this case, children lie with their faces turned to the wall, completely covered with a blanket;
• Very severe pain in the head, the patient reacts painfully to sounds, movements and light - limited movements appear when bending the neck, sometimes this even becomes impossible;
• it is impossible to straighten a leg that is bent at the knee;
• if you put the patient on the bed and try to tilt him towards his chest, his legs themselves will begin to bend at the knees;
• the nasolabial triangle becomes pale;
• the patient's concentration deteriorates and absent-mindedness appears;
• with this diagnosis in an infant, the child exhibits anxiety and concern, he is overly receptive to sounds and touches, and his sleep is disturbed;
• the patient refuses to eat and drinks liquids in large quantities;
• breathing is impaired;
• pressure readings drop and pulse quickens;
• a rash appears on skin with redness;
• convulsions begin.

There are other symptoms that may appear depending on the underlying cause that caused the meningismus.

Diagnostics

First, the doctor visually examines the patient - in this way, the presence of fever, rapid heartbeat or altered consciousness can be determined.

Main diagnostic procedure- lumbar puncture. After receiving cerebrospinal fluid it is being studied carefully. If necessary, the doctor prescribes additional examinations. It is mandatory to carry out standard lab tests- UAC, BAK, general analysis urine.

Lumbar puncture

Treatment of the disease

It is necessary to begin treatment for this syndrome immediately after the first signs appear. This should only be done by a qualified specialist in a hospital setting. Therapy will be aimed at reducing intracranial pressure.

Mainly used:

• medications for oral administration;
• intramuscular medications which will help relieve swelling.

Before prescribing, the doctor determines the cause of the syndrome. Every cause can be treated by specific means, For example:

• at bacterial disease therapy is carried out with antibiotics wide range;
• at viral disease antiviral drugs are prescribed.

Treatment is also carried out by other means that can:

• lower high temperature bodies;
• relieve pain;
• reduce the risk of seizures.

If for some reason the patient does not take the drugs on his own, they are injected into his spinal canal.

Possible complications

If treatment for meningism is not started in time, the complications will be very serious. The first thing that may occur is meningitis, in which paralysis of the arms and legs begins, others neurological diseases. Complications appear even after many years. Exclude death in this case it is impossible.

Prevention

To prevent the disease, you should adhere to the following recommendations:

• you should protect yourself from contact with people sick with infectious diseases;
• if an epidemic of the disease is declared, then it is necessary to avoid “crowds”, especially where there are small children - if this cannot be done, personal hygiene must be carefully observed;
• in an epidemiological situation, you should wear gauze bandage on the street;
• all diseases must be treated promptly and correctly;
• carry out wet cleaning of the premises in a timely manner;
• strengthen the immune system.

To cope with this insidious syndrome, you must follow all preventive measures and timely treatment of emerging diseases.

Most early symptoms meningitis are sharp headaches, aggravated by tapping on the skull and cheek bones, irritability, general malaise, vomiting and a more or less deep disorder of consciousness. Simultaneously with these general phenomena typical meningeal symptoms occur: Kernig's sign, Brudzinski's sign, stiff neck, and with basilar meningitis - signs of cranial nerve paresis in the form of ptosis, strabismus, facial asymmetry, etc.

Kernig's symptom is as follows: the patient, lying on his back, bends his leg at the hip and knee joints at a right angle, and then tries to straighten it in knee joint; this fails due to the reflex contraction of the leg flexors and the resulting pain from irritation of the roots. The second significant symptom of meningitis is Brudzinski's symptom.

There are upper and lower symptoms Brudzinsky: the first consists of bending the legs and pulling them to the stomach with a sharp passive flexion of the head, and the second is in bending the legs at the knee and hip joints with passive flexion of the other leg. Almost constant symptom meningitis is also Babinski's symptom, depending on concomitant encephalitis.

In addition, ChinaStokes or Biot breathing, pronounced bradycardia as a result of increased intracranial pressure, a scaphoid-shaped retracted abdomen and the characteristic position of the patient in bed with legs bent at the hip and knee joints are typical for meningitis, and it can be noted that if the patient stretches his legs, then he, left to its own devices, it immediately resumes its original position.

Symptoms of epidemic meningitis include a violent onset, higher temperature, herpes labialis et nosalis, which appears on the 5-6th day of illness, and sometimes exanthema, thanks to which it can be distinguished from tuberculous meningitis. In diagnostic and prognostic terms, it is extremely important to distinguish between meningism, i.e. irritation meninges, from true meningitis, and also to differentiate epidemic meningitis from tuberculous.

For this purpose, it is necessary to perform a lumbar puncture followed by examination of the cerebrospinal fluid. For purulent meningitis characterized by a turbid liquid containing neutrophils and specific pathogens, for tuberculosis - clear liquid With increased content protein (normally 0.2-0.3%), which produces a cobweb-like clot when standing and lymphocytes in the sediment: with meningism, cerebrospinal fluid is within normal limits, but intracranial pressure is always increased.

Differentiate between meningitis and meningism often based only on clinical symptoms, seems difficult. Differential diagnosis between meningitis and meningism can sometimes be made only on the basis of the course of the disease and cerebrospinal fluid tests. In addition, one should keep in mind the possibility of subarachnoid hemorrhage, in which typical meningeal symptoms are observed, not much different from those with meningitis.

Subarachnoid hemorrhages are observed with vascular diseases and especially when hypertension. Therefore, when meningeal symptoms in hypertensive patients, especially if they occur acutely, you must first think about the possibility of subarachnoid hemorrhage. In doubtful cases, the issue is resolved by lumbar puncture, the indications for which should be established by a neurologist. Timely detection of subarachnoid hemorrhage is important due to the fact that such patients need maximum rest and their transportation is associated with a known risk.

1) patient K., 17 years old, while in the suburbs, while dancing, felt a sudden severe headache in her head, fell and lost consciousness for 10 minutes, after which there were severe headaches, vomiting and an increase in temperature to 37.2°. The vomiting persisted for 2 days, for which reason the patient was sent to the hospital (5 km away), where she remained for 5 days. Upon arrival in the city, the patient went to the clinic, where they refused to issue her a sick leave certificate.

In the evening of the same day, the patient's headaches intensified, repeated vomiting and loss of consciousness reappeared. In the nervous clinic, a diagnosis of subarachnoid hemorrhage was made and, despite everything Taken measures, the patient died. The section revealed spontaneous subarachnoid hemorrhage with accumulation blood clots under the membranes of the right parietal lobe in the Sylvian fissure, in the area of ​​the optic chiasm and olfactory tracts, with slight softening of the cerebral cortex in the area of ​​the lower surface of the right frontal lobe and left-sided focal pneumonia.

This observation is extremely instructive, since it shows that a clinic doctor often evaluates a disease only by its condition. internal organs or, even worse, by the presence or absence of an increase in temperature, forgetting about the possibility of severe injuries nervous system or other systems without a temperature response and without sufficient anamnestic data.

2) Another patient G., 44 years old, who also suddenly developed severe subarachnoid hemorrhage, was urgently hospitalized, and after long-term treatment Her ability to work was completely restored, and she has been working to this day (over 6 years).

These two examples show the exceptional importance of the correctness of the doctor’s tactics in case of subarachnoid hemorrhage.

Treatment of meningitis should always be carried out in a hospital, so the slightest suspicion of meningitis should always be a reason for hospitalization of the patient. Treatment of meningitis should be aimed at eliminating the infection that caused the disease, as well as eliminating painful symptoms.

Streptomycin is used to treat tuberculous meningitis, which often produces amazing results. Symptomatic treatment meningitis consists primarily of a lumbar puncture aimed at reducing intracranial pressure. Lumbar puncture usually gives an excellent, albeit short-term effect, headaches are reduced, the patient is brought out of a coma, his general state improves significantly.

In addition, it is recommended to prescribe cold on the head, as well as sedatives. The role of a general practitioner at the bedside of a patient with meningitis should essentially be limited to the timely detection of symptoms of the disease and timely consultation with a neurologist, since the possibility of transporting the patient and especially therapy should be established by the neurologist.

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

1. Rigidity of the neck muscles, preventing passive flexion of the head and severe cases causing the head to tilt back.

It should be remembered that stiff neck muscles, especially in the elderly, may be a consequence cervical osteochondrosis or spondylosis, myositis, trauma or metastatic lesion cervical region, as well as parkinsonism, paratonia, tumor or congenital anomaly in the area of ​​the craniovertebral junction (foramen magnum). Paratonia - increase 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. Unlike all these conditions, with meningitis, only neck flexion is difficult, but not its rotation or extension.

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

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

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

5. Reactive pain phenomena: sharp pain upon palpation of the exit points of the branches trigeminal nerve, occipital nerves, when pressing from the inside on the front wall of the outer ear 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 disturbance of the breathing rhythm (Cushing reflex), unilateral dilation of the pupil with loss of its reaction to light, unilateral or bilateral damage to the abducens nerve, persistent hiccups, the appearance of signs of congestion in the fundus.

The most common reasons meningeal syndrome consists of 3 groups of diseases: infections of the central nervous system (meningitis, encephalitis, brain abscess), cerebrovascular diseases (subarachnoid or intracerebral hemorrhage), traumatic brain injury. Less often meningeal syndrome cause space-occupying formations of the posterior cranial fossa, carcinomatosis and leukemic infiltration of the meninges, vasculitis.

Combination of meningeal syndrome with general symptoms infections, especially fever, chills, muscle pain, requires first of all to exclude meningitis. It must be taken into account that early stage diseases, in children, elderly people, patients suffering from alcoholism, as well as in deep coma, meningeal symptoms may be absent. IN similar cases the disease may develop subacutely and manifest itself as increasing stupor or delirium without clear meningeal symptoms, and sometimes without fever. When collecting anamnesis, it is important to find out whether the onset of signs of meningitis was preceded by symptoms of nasopharyngitis, sinusitis, otitis media, pneumonia or other infectious diseases.

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). Purulent meningitis is more dangerous. Sometimes they occur at lightning speed and within a few hours lead to coma associated with severe cerebral edema. The slightest delay in starting antibacterial therapy can lead to persistent disabling complications and even death. Serous meningitis has a more benign course, in particular, it never causes severe depression of consciousness, epileptic seizures, or lesions. cranial nerves or brain substances and require in most cases only supportive or symptomatic therapy. Subacutely 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, sinusitis, mastoiditis, pneumonia, measure blood pressure, palpate regional The lymph nodes. In severe cases of meningococcal meningitis, a characteristic hemorrhagic petechial and purple rash occurs, which has the appearance of stars of various sizes and shapes and is localized on the torso and lower extremities (in the area of ​​the buttocks, thighs, legs). Petechiae can also be on the mucous membranes, conjunctiva, and 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 the emergency doctor is to suspect meningitis and transport the patient to an infectious diseases or specialized neuro-infectious department as quickly as possible. In the absence of such departments, hospitalization in neurological department. To confirm the diagnosis, a lumbar puncture is urgently performed in the emergency room or department.

However, lumbar puncture can be dangerous due to the possibility of herniation - displacement of brain matter 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 sharp intracranial hypertension or a space-occupying process (steadily increasing focal or cerebral symptoms, signs of damage to the posterior cranial fossa - cranial nerve dysfunction, cerebellar ataxia), examine the fundus (to identify congestive discs optic nerves) or perform echoencephaloscopy (exclude displacement midline structures). Contraindications to puncture are signs of incipient herniation (increasing depression of consciousness, unilateral dilation of the pupil, respiratory rhythm disturbance, decortication or decerebrate rigidity - see Part II, Coma). There should be no fear of complications from the puncture if it is performed with normal pupil reaction, in the absence of congestive optic discs and focal neurological symptoms. The risk of herniation is less if the puncture is performed with a thin needle, mannitol (1 g/kg) is infused intravenously 30 minutes before the puncture, and during puncture no more than 3-5 ml of cerebrospinal fluid (CSF) is carefully removed without removing the mandrel completely.

In purulent meningitis, the CSF is turbid, predominantly contains neutrophils, and total cells (cytosis) exceeds 1000 in 1 µl. At 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 repeated puncture (after 8-12 hours) allows one to avoid a diagnostic error.

Emergency care at the prehospital stage includes maintaining breathing and circulation, stopping pain syndrome, vomiting (metoclopramide, 10 mg intravenously), epileptic seizures (diazepam, 5-10 mg intravenously over 2-3 minutes), psychomotor agitation (diazepam, sodium hydroxybutyrate, 2 g intravenously, haloperidol, 5 mg intravenously or intramuscularly). To reduce intracranial hypertension, dexamethasone (8 mg), Lasix (20-40 mg), and in severe cases, mannitol (0.25-1 g/kg intravenous drip over 15-20 minutes) are administered intravenously. At high fever measures to reduce temperature are necessary. If signs of infectious-toxic shock appear, it is necessary to establish intravenous fluid administration ( isotonic solution sodium chloride, polyglucin) in combination with corticosteroids and vasopressors (mesaton, norepinephrine, dopamine). In case of severe arterial hypertension, you should carefully reduce blood pressure, avoiding sharp fall. Moderate arterial hypertension does not require correction.

In case of fulminant course of purulent meningitis, the first dose of antibiotic can be administered at the prehospital stage. In adults with normal immunity, the drugs of choice continue to be penicillin, 4 million units intravenously (6 times a day) or ampicillin, 3 g intravenously (4 times a day). However, taking into account the emergence of strains of pneumococci and meningococci resistant to penicillin in last years Cephalosporins are increasingly used III generation- for example, cefotaxime (claforan), 2 g intravenously 4 times a day. If you are allergic to penicillin or cephalosporins, use chloramphenicol, 1 g intravenously 3 times a day. In newborns, a combination of cefotaxime, 50 mg/kg intravenously and ampicillin, 50-100 mg/kg (4 times a day) or ampicillin and gentamicin at a dose of 1-2 mg/kg intravenously (3 times a day) is used, in children over 2 month - third 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 lightning-fast course. The most common type 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. In herpetic encephalitis, the temporal and frontal lobes are predominantly affected, therefore early manifestation This disease may include changes in behavior, speech, taste and smell, auditory, gustatory or olfactory hallucinations. At the same time, fever develops headache, confusion or stupor, partial and generalized epileptic seizures, focal symptoms (aphasia, hemiparesis).

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

Similar symptoms are observed with bacterial endocarditis, causing septic embolism, and brain abscess. Bacterial endocarditis may be indicated by a murmur detected on cardiac auscultation. Brain abscess is more often observed in young people and is manifested by a headache, which can be localized in half 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 may be suspected in patients with purulent diseases lungs, teeth, skin, pelvic organs, congenital defect heart with right-to-left shunting (tetralogy of Fallot, defect interventricular septum etc.), reduced immunity (with diabetes mellitus, malignant neoplasms, AIDS), chronic diseases 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 and repeated vomiting (see Part II, Stroke). Subarachnoid hemorrhage may be associated with rupture of an aneurysm and occasionally occurs with dissection carotid artery, leukemia and thrombocytopenia, blood clotting disorders. Combination of meningeal syndrome with focal disorders may indicate intracerebral hemorrhage or hemorrhage into a brain tumor, and a combination of neck muscle stiffness and back pain (in the absence of headache) - a rupture of a spinal arteriovenous malformation.

Headache and stiff neck muscles often occur with severe intracranial hypertension, especially with rapidly growing space-occupying formations in the posterior cranial fossa, causing hydrocephalus and herniation of the cerebellar tonsils into the large foramen magnum. An example is a cerebellar hematoma or extensive ischemic stroke of the cerebellum, tumors of the posterior cranial fossa. Sharp picture with a sharp headache, vomiting, stupor, stiffness of the neck muscles, and 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, and epileptic seizures. Diagnosis is possible by identifying extracerebral pathology (for example, pathology of the kidneys, peripheral nervous system) and laboratory testing.

Meningism(anat. meninges meninges) - meningeal syndrome of non-inflammatory origin, developing as a result of mechanical or toxic irritation of the meninges.

Meningism may occur with increased intracranial pressure (see. Intracranial hypertension), disturbance of cerebrospinal fluid circulation with expansion of the cerebrospinal fluid cavities of the brain (see. Hydrocephalus), cerebral edema and its membranes for intracranial tumors, various intoxications, infectious diseases(especially in children), closed traumatic brain injury, hemorrhagic stroke, intrathecal hemorrhages, meningeal carcinomatosis. Meningismus is also the main manifestation of the so-called post-puncture syndrome, which develops as a result of a decrease in cerebrospinal fluid pressure, edema and hyperemia of the meninges after the extraction of cerebrospinal fluid from the subarachnoid space during spinal and suboccipital punctures. Liqueur hypotension, accompanied by meningism, can be observed with severe dehydration (dehydration) of the body, for example with heat stroke, hungover. The occurrence of meningism is caused by irritation of the receptors of the meninges innervated by the branches of the trigeminal and vagus nerve, as well as fibers of the perivascular sympathetic plexuses.

Clinically, meningism is manifested by a triad of meningeal symptoms: headache, usually accompanied by nausea, less often vomiting: stiffness of the neck muscles, Kernig’s and Brudzinski’s symptoms; skin hyperesthesia and increased sensitivity to auditory and light stimuli (see. Meningitis). Headache is often postural in nature, i.e. appears and intensifies during the transition to vertical position. It can be diffuse or predominant in the occipital and fronto-orbital regions with irradiation to the neck. There is pain when tapping on the cranial vault, pressure on the trigeminal and occipital points (see. Pain points). The remaining meningeal symptoms with meningism are usually less pronounced than with meningitis. However, in children with significant general intoxication caused, for example, by pneumonia, influenza, measles, meningism can be pronounced and mask the manifestations of the underlying disease, creating diagnostic difficulties.

In the diagnosis of meningism and the differential diagnosis of this syndrome with meningitis, the study of cerebrospinal fluid is crucial. With meningism, the cerebrospinal fluid is usually not changed, only an increase in its pressure is noted. If liquor hypotension is suspected, puncture of the subarachnoid space with diagnostic purpose is not carried out. The question of the need for hospitalization of patients with meningism is decided by a neurologist.

Treatment is aimed at eliminating the causes that caused meningism (treatment of infectious diseases, removal of intoxication, reduction of intracranial pressure during intracranial organic processes, etc.). The prognosis is usually favorable, meningism quickly disappears with regression of the underlying disease.

Bibliography: Bojaeeni 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.

MENINGISM (meningismus; grech, meninx, meningos meninges) - clinical manifestation irritation of the meninges, characterized by the presence of meningeal symptoms (stiff neck, Kernig's, Brudzinski's symptoms, etc.) without inflammatory changes in the cerebrospinal fluid. M. in most cases is associated with increased intracranial pressure due to overproduction or impaired resorption of cerebrospinal fluid (hydrocephalus) or edema of the brain and its membranes. It can be observed with many inf. diseases occurring with intoxication - pneumonia, acute dysentery, salmonellosis, abdominal and typhus, sore throat, flu, infectious mononucleosis and others, for brain tumors and meningeal processes in the posterior cranial fossa, for traumatic brain injuries, acute disorders cerebral circulation.

Phenomena of M. with inf. diseases are more common in children. They usually occur in acute period illness and persist for 2-4 days, quickly disappearing when reverse development underlying disease.

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

Swelling of the brain and its membranes during traumatic brain injury also usually occurs with symptoms of M., which can develop even in cases where the injury is not accompanied by intrathecal hemorrhage. More often M. develops immediately after injury, but sometimes with minor injury or medium degree, some time after it; in such cases, meningeal symptoms are caused by developing hyperproductive hydrocephalus.

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

Diagnosis M. is based on the presence of meningeal symptoms, which, as a rule, are weakly expressed and quickly disappear. For differential diagnosis with meningitis (see), the study of cerebrospinal fluid (see) and the nature of the course of the disease are of primary importance. Cerebrospinal fluid with M. usually flows out under high blood pressure, but has normal composition. Only occasionally noted slight increase protein content due to an increase in the amount of albumin, or, conversely, a decrease in the number of cells and protein (cerebrospinal fluid with hydrocephalus).

IN initial stage meningitis, especially tuberculous and meningococcal, when the pathogen has already penetrated the meninges, inflammatory changes in the cerebrospinal fluid may still be absent. The M. observed in these cases is apparently caused by excess production of cerebrospinal fluid and limited swelling of the meninges. When re-examining the cerebrospinal fluid, carried out a day later, pleocytosis and a moderately increased protein content can sometimes be detected.

Treatment comes down to reducing intracranial pressure (see) and eliminating the causes of M. In order to lower intracranial pressure, diuretics are prescribed, of which diacarb, which inhibits the function of the choroid plexuses, is preferable. 25% is administered intramuscularly sulfate solution magnesium

With M. in patients with inf. In diseases, spinal puncture has a positive effect (see); for hydrocephalus, the effect of this therapy is short-term. If a tumor of the brain stem and posterior cranial fossa is suspected, lumbar puncture is performed only in a neurosurgical hospital.

Bibliography: Mauthner G. Meningitis and meningism, trans. from German, M., 1927; Pokrovsky V.I., Favorova L.A., and Kostyukova N.N. Meningococcal infection, p. 172, M., 1976; X e g l i n R. Differential diagnosis of internal diseases, trans. with German, p. 130, 153, M., 1965; Shamburov D. A. Cerebrospinal fluid, M., 1954.

V. I. Pokrovsky.

Etiology

The human immune system protects the brain very well. But if it happens that with a weak immune system, the infection still gets there, the body still tries to fight it. Paradoxically, this only makes the situation worse.

Due to the fact that at this time red and white cells begin to be produced in excess and enter the brain, inflammatory processes begin that can result in edema. If nothing is done, the access of blood and oxygen to the brain will be blocked. The further development of the infectious disease will worsen.

Clinicians identify the following causes of meningism:

Children's meningism syndrome can even occur due to ARVI and high blood pressure.

Symptoms

All signs indicating meningism occur quickly, so it will not be difficult for the doctor to recognize them.

Symptoms of developing meningism:

• a sick child has chills that turn into fever;
• mental disorders: confusion, amnesia, sometimes mental disorders appear;
• nausea, sometimes with severe vomiting;
• Photophobia occurs - in this case, children lie with their faces turned to the wall, completely covered with a blanket;
• very severe pain in the head, the patient reacts painfully to sounds, movements and light - limited movements appear when bending the neck, sometimes it even becomes impossible;
• it is impossible to straighten a leg that is bent at the knee;
• if you put the patient on the bed and try to tilt him towards his chest, his legs themselves will begin to bend at the knees;
• the nasolabial triangle becomes pale;
• the patient's concentration deteriorates and absent-mindedness appears;
• with this diagnosis in an infant, the child exhibits anxiety and concern, he is overly receptive to sounds and touches, and his sleep is disturbed;
• the patient refuses to eat and drinks liquids in large quantities;
• breathing is impaired;
• pressure readings drop and pulse quickens;
• a rash appears on the skin with redness;
• convulsions begin.

There are other symptoms that may appear depending on the underlying cause that caused the meningismus.

Diagnostics

First, the doctor visually examines the patient - in this way, the presence of fever, rapid heartbeat or altered consciousness can be determined.

The main diagnostic procedure is lumbar puncture. Once the cerebrospinal fluid is obtained, it is carefully examined. If necessary, the doctor prescribes additional examinations. Standard laboratory tests are mandatory - CBC, LBC, general urinalysis.

Treatment

It is necessary to begin treatment for this syndrome immediately after the first signs appear. This should only be done by a qualified specialist in a hospital setting. Therapy will be aimed at reducing intracranial pressure.

Mainly used:

• medications for oral administration;
• intramuscular medications to help relieve swelling.

Before prescribing medications, the doctor determines the cause of the syndrome. Each cause is treated with specific means, for example:

• for a bacterial disease, therapy is carried out using broad-spectrum antibiotics;
• For a viral disease, antiviral drugs are prescribed.

Treatment is also carried out by other means that can:

• reduce high body temperature;
• relieve pain;
• reduce the risk of seizures.

If for some reason the patient does not take the drugs on his own, they are injected into his spinal canal.

Possible complications

If treatment for meningism is not started in time, the complications will be very serious. The first thing that may occur is meningitis, which causes paralysis of the arms and legs, epilepsy and other neurological diseases. Complications appear even after many years. It is impossible to exclude a fatal outcome in this case.

Provoking factors

Brain in human body, usually defends fairly well with immune system. But if the patient’s immunity is weakened, and pathogenic bacteria After all, they penetrate the brain, 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 swelling of the brain. If the situation continues to develop, blood and oxygen will stop flowing to the brain. In addition, the course of the infectious disease will only worsen.

What reasons can cause meningism:

Characteristic manifestations

Symptoms and manifestations of meningism appear very quickly, and it will not be difficult for a qualified specialist to recognize them:

Establishing 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.

Health care

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 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 - meningitis, which is very often accompanied by complete paralysis of the limbs, epileptic seizures, and other neurological problems.

For prevention purposes

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

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.