Meningeal Syndrome: An 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 cerebrospinal fluid. Synonyms - shell syndrome, syndrome of irritation of meninges.

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Epidemiology

Epidemiology of the meningeal syndrome depends on the nature and frequency of the diseases causing it.

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What causes meningeal syndrome?

Meningeal syndrome (meningism) develops due to irritation of the meninges in inflammatory diseases, increased intracranial pressure, craniocerebral trauma, tumors, intoxications, hypoxia and many other pathological conditions.

The basis is either swelling 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 permanent or transient, usually quite intense, diffuse or local, mainly in the forehead and occiput. Vomiting is not associated with eating, without nausea, "flowing", does not bring relief. General hyperesthesia is manifested by increased sensitivity of the skin to sound and light stimuli.

A specific posture is formed when the meningitis is expressed: the head is thrown back, the body is arched, the stomach is drawn in, the legs are brought to the stomach (pose of the "dog", "cocked cock").

How does the meningeal syndrome manifest itself?

Rigidity of the occipital muscles, when trying to bend the head, there is a sharp increase in pain, the tension of the muscles of the extensors of the cabbage soup, the chin lacks the sternum Kernig symptom - the impossibility to unbend the leg, previously bent at right angles in the knee and hip joint (differentiated with the Lassega symptom characteristic of radicululgia). Brudzinsky symptoms:

1. upper - involuntary bending of the legs in the knee joints when trying to lead the head to the sternum;
2. zygomatic - the same reaction with percussion of the zygomatic arch;
3. pubic - bending of the legs in the knee joints when pressing on the lonnoe articulation;
4. lower (performed simultaneously with the symptom of Kernig) - when trying to unbend the leg in the knee joint, the second leg involuntarily bends.

Guillain - when squeezing the quadriceps muscle of the thigh, the other leg bends and is brought to the stomach, Meithus - the patient is fixed with his legs extended by the hand, and the other helps sit down - he can not sit straight with his legs straight. Fanconi - the patient can not sit in bed with his knees flexed and fixed.

"Treader" - the patient can sit in bed; Only leaning his hands behind his back. "Kiss of the knee" - even with bent and tightened legs, the patient can not reach them with his lips. Bechterew zygomatic - with percussion of the zygomatic arch, hunger pain intensifies and a painful grimace appears.

In children, meningeal syndrome has such symptoms: convulsions, high body temperature, vomiting, plentiful regurgitation, bulging or straining of the large fontanel, strabismus, pupil narrowing, paresis of limbs, hydrocephalic cry - the child unconsciously screams and covers his head with hands. Characteristic: Lesage (hanging) - the child lifted under the arms pulls the legs to the stomach and can not unbend it, the head is thrown back (the limbs move in a healthy child); Flutus - dilated pupils with rapid tilt of the head.

Paralysis and paresis often develop in the defeat of the central nervous system, less often the spinal cord.

When the process is localized, the function of the cranial nerves, the earliest of the oculomotor nerves, is rapidly affected at the base of the brain: ptosis, strabismus, anisocoria, and ophthalmoplegia. Meningeal syndrome can be accompanied by the defeat of other nerves. At the beginning of the process, tendon reflexes are increased, then decrease or completely disappear. Abdominal reflexes are always reduced: When the pyramidal pathways are involved, the meningeal syndrome is characterized by the appearance of pathological reflexes: Babinsky (plantar) - when the soles from the heel to the first finger are irritated, the first finger extends markedly, others spread out in a fan and often stand in the position of plantar flexion (symptom " fan "), Balduzzi - with a slight impact on the soles of the hammer, adduction and rotation of the shins occur, Oppenheim - with the pressure on the toes of the foot, the first finger acquires a position inflection.

Classification

At the heart of the meningeal syndrome lie the causes of a different nature. It is necessary to share meningitis and meningism. Meningitis - 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 cerebrospinal fluid. Meningism - the presence of meningeal symptoms in the absence of liquorological signs of inflammation, primarily, with its normal cellular and biochemical composition.

• Meningitis:
  • acute purulent (pathogen - meningococcus, pneumococcus, hemophilic rod, etc.);
  • acute serous (pathogens - Coxsackie viruses, ECHO, mumps, herpes, etc.);
  • subacute and chronic (pathogens - Koch's stick, brucella, fungi, etc.).
• Meningism:
  • caused by irritation of the meninges and changes in liquor pressure:
    • subaharnoidal hemorrhage;
    • acute hypertensive encephalopathy;
    • occlusive syndrome with volumetric processes in the cranial cavity (tumor, parenchymal or hepatoma, abscess, etc.);
    • carcinomatosis (sarcoidosis, melanomatosis) of the meninges;
    • pseudotumor syndrome;
    • radiation encephalopathy;
  • toxic:
    • exogenous intoxications (alcoholic, hyperhydration);
    • endogenous intoxications (hypoparathyroidism, malignant neoplasms);
    • with infectious diseases not accompanied by damage to the meninges (influenza, salmonella, etc.);
  • pseudo-meningeal syndrome.

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

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How is the meningeal syndrome recognized?

Meningeal syndrome is an absolute indication for hospitalization in. Neurosurgical department, and when in other departments of the hospital for immediate call of a neurosurgeon and neurologist, since the whole complex of instrumental examination should be carried out only in the conditions of a neurosurgical department: radiography of the skull, ultrasound echolocation, spinal puncture; according to indications determined by a neurosurgeon and neuropathologist, carotid angiography, magnetic resonance imaging, ultrasound dopplerography of brachiocephalic arteries and transcranial dopplerography, rheography and electroencegraphy. The patient must necessarily be consulted by a neurologist and otoneurologist.