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Meningeal syndrome - Diagnosis
Last reviewed: 06.07.2025
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Emergency medical care for meningeal syndrome
When clinical manifestations of meningeal syndrome are detected in a patient, the primary task is to establish the nature of the disease that caused it. It is imperative to exclude traumatic, inflammatory and other diseases of the brain accompanied by volumetric impact. For this purpose, it is necessary to conduct CT or MRI of the head (X-ray of the skull bones is less informative, although it allows diagnosing bone traumatic changes), examination of the fundus, and assess the possibility of performing a lumbar puncture, taking into account contraindications to its implementation.
In case of acute meningeal syndrome, the patient must be taken to hospital. The nature and scope of medical care provided at the pre-hospital stage is determined by the cause of the disease, as well as the severity of the patient's condition. The main directions are eliminating the threat to the patient's life due to the existing disease (for example, ensuring airway patency), relieving pain, and maintaining vital body functions.
Diagnosis of meningeal syndrome
The diagnostic algorithm can be presented as follows.
- Detection of meningeal syndrome.
- Establishing the nature of previous diseases (infectious, trauma, arterial hypertension, neoplasms).
- Exclusion of intracranial volumetric lesion (optimally - MRI/CT, if they are absent - ophthalmoscopy, EchoES).
- In the absence of contraindications - lumbar puncture with biochemical, microscopic, bacteriological examination of cerebrospinal fluid (if indicated - PCR, immunological tests).
Anamnesis
To diagnose meningitis, it is necessary to find out the presence of recent infectious diseases, fever, persistent headache with nausea. The occurrence of meningeal syndrome along with intense headache, depression of consciousness due to trauma or against the background of physical or emotional stress allows us to assume the presence of, respectively, traumatic or spontaneous subarachnoid hemorrhage. Oncological diseases in the anamnesis, unexplained weight loss allow us to suspect an oncological lesion.
Physical examination
Physical examination includes neurological examination, assessment of the somatic condition (blood pressure, pulse, skin condition, auscultation of the lungs and heart). Examination of the ENT organs and the condition of the gums is valuable for identifying the suspected source of infection in a patient with secondary meningitis.
A thorough examination of the scalp and detection of bloody or clear discharge from the nasal and external auditory canals is important to establish traumatic injuries.
Laboratory research
The most important method for establishing the cause of meningeal syndrome is diagnostic lumbar puncture with subsequent analysis of cerebrospinal fluid. This method becomes decisive for confirming the diagnosis of subarachnoid hemorrhage and meningitis. The presence of a clinical picture of meningitis is the basis for mandatory diagnostic puncture.
Instrumental research
If there is a suspicion of a volumetric lesion of the brain, an inflammatory disease of the ENT organs, potentially capable of becoming a source of secondary meningitis, it is necessary to conduct MRI/CT. Patients with a history of oncological diseases, when structural changes in the brain tissue are detected according to the results of a neuroimaging study, especially with a displacement of brain structures, must undergo MRI with the introduction of a contrast agent.
X-ray of the skull has a certain diagnostic value in identifying traumatic lesions of the cranial bones and inflammatory diseases of the paranasal sinuses. Identification of edema of the optic nerve papilla and its secondary atrophy helps to diagnose cerebrospinal fluid hypertension. Echoencephaloscopy is an express method that allows one to assume the presence of a volumetric supratentorial lesion. The method is not informative enough in diagnosing cerebrospinal fluid hypertension and establishing the nature of the lesion.
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