Meningeal syndrome - Overview

Meningeal syndrome occurs due to irritation of the meninges, characterized by the presence of meningeal symptoms in combination with changes in pressure, cellular and chemical composition of the cerebrospinal fluid. Synonyms - meningeal syndrome, meningeal irritation syndrome.

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Epidemiology

The epidemiology of meningeal syndrome depends on the nature and frequency of the diseases that cause it.

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What causes meningeal syndrome?

Meningeal syndrome (meningism) develops as a result of irritation of the meninges during inflammatory diseases, increased intracranial pressure, traumatic brain injury, tumors, intoxication, hypoxia and many other pathological conditions.

The basis is either edema and swelling of the membranes of the brain, or compression of the brain. Meningeal syndrome is accompanied by a number of specific manifestations: headache, vomiting, dizziness, general paresthesia, specific posture and symptoms.

Headaches can be constant or transient, usually quite intense, diffuse or local, mainly in the forehead and back of the head. Vomiting is not associated with food intake, without nausea, "gushing", does not bring relief. General hyperesthesia is manifested by increased sensitivity of the skin to sound and light stimuli.

A specific posture is formed in cases of severe meningitis: the head is thrown back, the body is arched, the stomach is pulled in, the legs are drawn up to the stomach (the “pointing dog” or “cocked gun” posture).

How does meningeal syndrome manifest itself?

Rigidity of the occipital muscles, when trying to bend the head, a sharp increase in pain is noted, tension of the extensor muscles of the neck, the chin does not reach the sternum Kernig's symptom - the inability to straighten the leg, previously bent at a right angle at the knee and hip joint (differentiate with Lassegue's symptom characteristic of radiculalgia). Brudzinsky symptoms:

1. upper - involuntary bending of the legs at the knee joints when trying to bring the head to the sternum;
2. zygomatic - the same reaction upon percussion of the zygomatic arch;
3. pubic - bending the legs at the knee joints with pressure on the pubic symphysis;
4. lower (performed simultaneously with the Kernig symptom) - when trying to straighten the leg at the knee joint, the second leg involuntarily bends.

Guillain - when squeezing the quadriceps muscle of the thigh, the other leg is bent and brought to the stomach, Meitus - the patient's straightened legs are fixed with one hand, and the other is helped to sit - he cannot sit upright with straightened legs. Fanconi - the patient cannot sit up in bed with straightened and fixed knees.

"Tripod" - the patient can sit in bed; only by leaning his hands behind his back. "Kissing the knee" - even with bent and pulled-up legs the patient cannot reach them with his lips. Bekhterev's zygomatic - when percussing the zygomatic arch, hunger pain intensifies and a painful grimace appears.

In children, meningeal syndrome has the following symptoms: convulsions, high body temperature, vomiting, profuse regurgitation, bulging or tension of the large fontanelle, strabismus, constriction of the pupils, paresis of the limbs, hydrocephalic cry - the child in an unconscious state screams and clasps his head with his hands. Characteristic: Lesage (suspension) - a child raised under the armpits pulls his legs to his stomach and cannot straighten them, the head is thrown back (in a healthy child, the limbs are mobile); Flatua - dilation of the pupils with a quick tilt of the head.

Paralysis and paresis most often develop with damage to the central nervous system, less often the spinal cord.

When the process is localized mainly at the base of the brain, the function of the cranial nerves is quickly affected, most early the oculomotor nerves: ptosis, strabismus, anisocoria, ophthalmoplegia. Meningeal syndrome may be accompanied by damage to other nerves. At the beginning of the process, tendon reflexes are increased, then decrease or disappear completely. Abdominal reflexes are always decreased: When the pyramidal tracts are involved in the process, meningeal syndrome is characterized by the appearance of pathological reflexes: Babinski (plantar) - when irritating the sole from the heel to the first toe, a pronounced extension of the first toe is noted, the others spread out like a fan and often stand in a position of plantar flexion (the "fan" symptom), Balduzzi - with a light blow to the sole with a hammer, adduction and rotation of the shin occurs, Oppenheim - when pressing on the toes, the first toe acquires a flexion position.

Classification

Meningeal syndrome is based on various causes. It is necessary to distinguish between meningitis and meningism. Meningitis is an inflammatory lesion of the membranes of the brain and spinal cord - a condition characterized by a combination of clinical meningeal symptoms and inflammatory changes in the cerebrospinal fluid. Meningism is the presence of meningeal symptoms in the absence of cerebrospinal fluid signs of inflammation, primarily with its normal cellular and biochemical composition.

• Meningitis:
  • acute purulent (pathogen - meningococcus, pneumococcus, Haemophilus influenzae, etc.);
  • acute serous (pathogens - Coxsackie, ECHO, mumps, herpes viruses, etc.);
  • subacute and chronic (pathogens - Koch's bacillus, brucella, fungi, etc.).
• Meningism:
  • caused by irritation of the meninges and changes in cerebrospinal fluid pressure:
    • subaccharoidal hemorrhage;
    • acute hypertensive encephalopathy;
    • occlusion syndrome in case of volumetric processes in the cranial cavity (tumor, parenchymal or subthecal hematoma, abscess, etc.);
    • carcinomatosis (sarcoidosis, melanomatosis) of the meninges;
    • pseudotumor syndrome;
    • radiation encephalopathy;
  • toxic:
    • exogenous intoxication (alcohol, hyperhydration);
    • endogenous intoxications (hypoparathyroidism, malignant neoplasms);
    • for infectious diseases not accompanied by damage to the meninges (flu, salmonellosis, etc.);
  • pseudomeningeal syndrome.

Sometimes a combination of several factors in the development of clinical meningeal syndrome is identified, for example, an increase in cerebrospinal fluid pressure and toxic effects on the membranes of the brain during subarachnoid hemorrhage.

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How is meningeal syndrome recognized?

Meningeal syndrome is an absolute indication for hospitalization in the neurosurgical department, and if in other departments of the hospital, for immediate call of a neurosurgeon and neuropathologist, since the entire complex of instrumental examination should be carried out only in the conditions of the neurosurgical department: X-ray of the skull, ultrasound echolocation, spinal puncture; according to indications determined by the neurosurgeon and neuropathologist - carotid angiography, magnetic resonance imaging, ultrasound Dopplerography of the brachiocephalic arteries and transcranial Dopplerography, rheography and electroencephalography. The patient must be consulted by a neuro-ophthalmologist and an otoneurologist.