Meningeal syndrome: diagnosis
Last reviewed: 23.04.2024
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Emergency medical care for meningeal syndrome
If a patient has clinical manifestations of meningeal syndrome, the first task is to establish the nature of the disease that caused him. It is necessary to exclude traumatic, inflammatory and other diseases of the brain, accompanied by a volumetric effect. For this purpose, CT or MRI of the head should be performed (less informative radiography of the bones of the skull, which allows to diagnose bony traumatic changes), examination of the fundus, evaluate 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 volume of medical care provided at the prehospital stage is due to the cause of the disease, as well as the severity of the patient's condition. The main directions are the elimination of the threat to the life of the patient due to the existing disease (for example, providing airway patency), relief of pain syndrome, maintenance of vital body functions.
Diagnosis of meningeal syndrome
The diagnostic algorithm can be represented as follows.
- Detection of meningeal syndrome.
- Establishment of the nature of previous diseases (infectious, trauma, arterial hypertension, neoplasms).
- Exclusion of intracranial volume lesion (optimal - MRI / CT, in their absence - ophthalmoscopy, Echo).
- In the absence of contraindications - lumbar puncture with the conduct of biochemical, microscopic, bacteriological study of cerebrospinal fluid (if there are indications - PCR, immunological tests).
Anamnesis
For diagnosis of meningitis, you should find out the presence of infectious diseases, fever, headache and nausea that have been transferred in the recent past. The emergence of meningeal syndrome, along with intense headache, depression of consciousness due to trauma or against the background of physical or emotional loads, suggests the presence, respectively, of traumatic or spontaneous subarachnoid hemorrhage. Oncological diseases in the anamnesis, inexplicable decrease in body weight allow to suspect oncological defeat.
Physical examination
Physical examination includes neurologic examination, assessment of the physical condition (blood pressure, pulse, skin condition, auscultation of the lungs and the heart). The examination of ENT organs, the condition of the gums, is valuable for identifying the alleged source of infection in a patient with secondary meningitis.
It is important to carefully inspect the skin of the head, detect bloody or transparent detachable from the nasal and external auditory canals for detecting traumatic lesions.
Laboratory research
The most important way to establish the cause of meningeal syndrome is a diagnostic lumbar puncture with subsequent analysis of cerebrospinal fluid. This method becomes decisive for confirming the diagnosis of subarachnoid hemorrhage and meningitis. Presence of a clinical picture of a meningitis - the basis for obligatory carrying out of a diagnostic puncture.
Instrumental research
If there is a suspicion of brain lesions, an inflammatory disease of the ENT organs, potentially capable of becoming a source of secondary meningitis, an MRI / CT scan is necessary. Patients with oncological diseases in history with the detection of structural changes in the brain substance from the results of neurovascularization, especially with the displacement of the brain structures, it is necessary to carry out MRI with the introduction of a contrast agent.
A certain diagnostic value in detecting traumatic lesions of the bones of the skull, inflammatory diseases of the paranasal sinuses is radiograph of the skull. Detection of the edema of the nipple of the optic nerve, its secondary atrophy contributes to the diagnosis of cerebrospinal fluid hypertension. Echoencephaloscopy is an express method that suggests the presence of a voluminous supratentorial lesion. The method is not sufficiently informative in diagnosing cerebrospinal fluid hypertension, establishing the nature of the lesion.
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