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Meningeal syndrome
Medical expert of the article
Last reviewed: 05.07.2025
[ What causes meningeal syndrome?
Meningeal syndrome may be caused by an inflammatory process caused by various microbial flora (meningitis, meningoencephalitis) or non-inflammatory lesions of the meninges. In these cases, the term "meningism" is used. In the case of inflammation, the etiologic factor may be bacteria (bacterial meningitis), viruses (viral meningitis), fungi (fungal meningitis), protozoa (toxoplasma, amoeba).
For differential diagnosis between inflammatory lesions of the meninges and meningism, it is necessary to examine the cerebrospinal fluid obtained by spinal puncture.
Symptoms of meningeal syndrome
The concept of “meningeal syndrome” includes subjective disorders and objective symptoms determined during examination of the patient.
Cardiac meningeal symptom - headache characterized by significant intensity (patients groan, clutch their heads, children scream), diffuseness (the whole head hurts) and a feeling of distension. Patients experience pressure on the eyes, ears, and back of the head. Headache may be accompanied by pain in the neck and along the spine, intensifies with a change in body position, loud sounds, bright light. With predominant damage to the spinal cord membranes, the headache may be moderate. It decreases after taking loop diuretics, after evacuation of cerebrospinal fluid during a spinal puncture.
Headache is usually accompanied by nausea and often vomiting. Vomiting is not associated with food intake, it occurs suddenly, like a fountain. In addition to increased sensitivity to acoustic and photo stimuli, pronounced hyperesthesia of the skin is noted. Painful sensations occur during palpation, stroking the skin of the outer surface of the thighs, shoulders and especially the abdomen, which, in combination with nausea and vomiting, imitates the picture of acute abdomen.
Of the objective symptoms of meningeal syndrome, the most demonstrative are rigidity of the occipital muscles, the upper and lower Brudzinsky symptoms, and the Kernig symptom. In children - the symptom of sitting ("tripod"), the Lesage symptom (suspension), in children under one year - bulging, tension, and cessation of pulsation of the large fontanelle.
The rigidity of the occipital muscles is checked in the supine position by bending the head with the jaws clenched. If the symptom is positive, the patient does not reach the sternum with his chin, which is due to increased muscle tone in the extensor muscles of the head. The severity of this symptom may be weak, when the patient does not reach the sternum with his chin by 1-2 cm, moderate - the chin does not reach the sternum by 3-5 cm, severe - the head does not bend from the vertical position or is thrown back. The rigidity of the occipital muscles should be distinguished from the radicular symptom of Neri, in which bending the head is difficult or impossible due to a pain reaction. Rigidity of the occipital muscles may be combined with the symptom of Neri. Difficulty bending the head may be associated with damage to the cervical spine (osteochondrosis) in older people.
Brudzinski's upper symptom is a reflex flexion of the legs at the hip and knee joints when bending the head (when checking the rigidity of the occipital muscles). Kernig's symptom is checked in a supine position on a flat surface. The leg is bent at the hip and knee joints at a right angle, and then extended at the knee joint. With a positive symptom, full extension is impossible due to increased tone of the flexor muscles. The symptom is checked on both sides. The severity of Kernig's symptom may vary - from sharply positive (the leg almost does not extend) to weakly positive (the leg can be extended almost completely). Kernig's symptom is usually expressed equally on both sides, but with differences in muscle tone in the limbs, the presence of leg paresis, asymmetry is possible. With a combination of meningeal and radicular syndromes, a pain reaction is likely when extending the leg. In these cases, it is necessary to check for the presence of Lasegue's symptom. Kernig's symptom can imitate knee joint lesions, which are accompanied by their stiffness. When checking Kernig's symptom, reflex flexion of the second leg in the hip and knee joints is possible - the lower Brudzinsky symptom.
In children, the symptom of sitting ("tripod") is indicative: the child is seated on a flat horizontal surface with legs extended forward. If the symptom is positive, he leans back and rests on his arms or bends his legs. In doubtful cases, the head can be bent forward. In this case, the legs bend. In children under one year, the Lesage (suspension) symptom is most demonstrative: the child is lifted, held by the armpits, while he pulls his legs to his stomach and cannot straighten them. With an open large fontanelle, its bulging, tension and cessation of pulsation are characteristic.
The severity of meningeal syndrome may vary - from insignificant to severe (in purulent meningitis). In the late stages of the disease, in the absence of adequate treatment, patients take a characteristic meningeal pose: on their side with their head thrown back and legs pressed to their stomach ("pointer dog pose"). The patient may have all meningeal symptoms - complete meningeal syndrome, or some symptoms may be absent - incomplete meningeal syndrome, which is often observed in serous viral meningitis.
With predominant damage to the membranes of the brain, the rigidity of the muscles of the back of the head is more pronounced; with involvement of the membranes of the spinal cord in the process - Kernig's symptom.
Where does it hurt?
What do need to examine?
What tests are needed?
Treatment of meningeal syndrome
Treatment of meningeal syndrome depends on the etiologic factor. In case of neuroinfections (meningitis, meningoencephalitis), etiotropic therapy is carried out, which is combined with pathogenetic therapy. In the absence of neuroinfection, pathogenetic therapy is carried out. Its main directions are:
- dehydration using loop and osmotic diuretics;
- detoxification by infusion of crystalloid (polyionic solutions, polarizing solution) and colloidal solutions in a ratio of 2:1 in a volume of 10 ml/kg of body weight or more:
- analgesics, sedatives.