Pachymeningitis

As is known, the human brain consists of several membranes - these are the hard, vascular and arachnoid membranes, which are endowed with certain important functions. The inflammatory process can occur under certain circumstances in any of them. Today we will talk about inflammation in the hard membrane, which in medical circles is called "pachymeningitis".

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Epidemiology

Pachymeningitis is most often found in infants and middle-aged men.

Outbreaks of the disease are diagnosed mainly in the spring-autumn period, which may be associated with sharp fluctuations in temperature, epidemics of infectious diseases, decreased immune protection in the population and seasonal vitamin deficiency.

The bacterial variant of pachymeningitis is mostly found in countries with hot climates, as well as in countries with poor health development.

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Causes pachymeningitis

When speaking about pachymeningitis, we usually mean an inflammatory process affecting the dura mater of the brain or spinal cord (cerebral or spinal pachymeningitis, respectively).

• Taking into account the layered inflammatory lesion of the dura mater, internal and external pachymeningitis are distinguished.
• Depending on the type of inflammatory changes, pachymeningitis can be serous, purulent and hemorrhagic, and depending on the nature of the process, it can be acute or chronic.

Serous pachymeningitis occurs as a result of various infections, poisoning and allergic processes.

Hemorrhagic pachymeningitis can be the result of trauma, atherosclerotic changes in blood vessels, decompensation of cardiac activity, diseases of the blood system, and increased intracranial pressure.

Purulent pachymeningitis occurs when infectious agents from other foci enter the cranial cavity - for example, with otitis, sinusitis, carbuncles or furuncles.

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Risk factors

Factors that increase the risk of developing pachymeningitis:

• childhood;
• any infectious pathologies;
• weakened immunity;
• working with people, frequent presence in public places (especially during epidemics);
• frequent long-distance travel, especially to exotic countries (for example, to African countries);
• head injuries and brain surgery.

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Pathogenesis

Pachymeningitis can occur in several patterns:

• hematogenous route, through the lymph, placenta or through the nerve sheaths;
• by contact, in the presence of a purulent process in the nasal sinuses, middle ear or mastoid process, in case of infectious diseases of the teeth or eyes;
• in case of head or spinal injury.

The pathogenetic mechanism is expressed in looseness, swelling and plethora of the dura mater. If the disease is hemorrhagic, then blood saturation and delamination of the dura mater is observed as a result of vascular damage. Blood can accumulate in individual cavities, with the formation of hygromas.

With purulent pachymeningitis, adhesions, extradural and subdural abscesses are formed. When the painful process subsides, meningeal fibrosis is formed.

The chronic process occurs with fibrosis, followed by tissue compaction and compression of nerve endings, which can lead to nerve atrophy.

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Symptoms pachymeningitis

Serous pachymeningitis often occurs without any symptoms, so it is discovered by chance.

Hemorrhagic pachymeningitis manifests itself in a variety of clinical signs, although minor hemorrhages can also be asymptomatic. During an exacerbation, headaches appear, which increase, complicated by bouts of vomiting, dizziness and loss of consciousness. Signs such as memory loss, general indifference - or, conversely, an overly excited state - may attract attention.

The first signs depend on the specific location of the lesion. Minor meningeal manifestations may be detected. In some patients, congestion of the optic nerve papillae or inflammation of the optic nerve is determined. During lumbar puncture, the cerebrospinal fluid comes out under pressure. An elevated protein level may be detected in it.

External pachymeningitis begins with localized pain in the head. When tapping on the cranium, pain can be felt on the affected side. Pachymeningitis against the background of an extradural abscess is characterized by severe headache in the temple area. The condition may be accompanied by seizures, aphasia, numbness of the limbs.

If inflammation develops near the apical part of the pyramid of the temporal bone, then severe pain is observed in the forehead, temples and eyeballs.

With internal purulent pachymeningitis, body temperature reaches 38-40°C, chills, debilitating headache with vomiting appear. Detachment, a feeling of fatigue, delirium, and convulsions are often noted.

Stages

The course of pachymeningitis can be divided into three stages:

1. The edema stage is accompanied by an excited or apathetic state, severe headache, nausea, digestive disorders, convulsions, and the appearance of pathological reflexes.
2. The stage of diffuse inhibition proceeds with obvious signs of CNS depression. Indifference, drowsiness are observed, headaches become less pronounced, and the temperature stabilizes.
3. The paralytic stage is characterized by the resumption of headaches, increased temperature, tachycardia, and loss of consciousness. This stage can be equated to a pre-comatose state.

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Complications and consequences

A number of complications may develop: deterioration of hearing and vision, epilepsy, intellectual disabilities, sepsis, astheno-neurotic syndrome.

With weakened immune defense, renal failure, adrenal pathologies, and cardiovascular disorders may develop.

When the infection spreads, generalized meningitis may occur, which is characterized by an extremely severe course. Often the patient dies from intoxication, toxic shock and massive intracerebral hemorrhages.

If the patient consulted a doctor in a timely manner, as a result of which pachymeningitis was completely cured, then in some cases residual effects of the disease may persist, which are expressed as:

• in headaches associated with changes in weather or climate;
• in numbness of the limbs, paralysis;
• in increased intracranial pressure;
• in the occurrence of epileptic seizures;
• in intellectual disorder;
• in the occurrence of vegetative disorders and diseases of the endocrine system.

In case of such complications, additional treatment is carried out, which is long-term and requires an individual approach.

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Diagnostics pachymeningitis

Diagnostic procedures for suspected pachymeningitis include questioning and neurological tests, as well as laboratory tests and instrumental examination.

Tests for pachymeningitis:

• general blood test (leukocytosis in pachymeningitis of bacterial origin, leukopenia in viral etiology of the disease, shift in the leukocyte formula to the left, accelerated ESR, in the last stages - thrombocytopenia);
• blood biochemistry (acidosis, increased creatinine and urea levels);
• latex agglutination tests or PCR (to determine the type of pathogen).

Instrumental diagnostics of pachymeningitis:

• cerebrospinal puncture with fluid collection for examination;
• electroencephalography with recording of the electrical activity of the brain;
• computed tomography with layer-by-layer examination of brain structures.

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Differential diagnosis

Differential diagnostics are carried out with blood entering the subarachnoid space, with intracerebral stroke, with tumor and purulent pathologies in the brain, with cerebral arachnoiditis.

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Treatment pachymeningitis

Pachymeningitis cannot be treated independently at home: the patient must be hospitalized.

After the final diagnosis, the patient is prescribed strong antibacterial drugs:

	Method of administration and dosage	Side effects	Special instructions
Ceftriaxone	Prescribed at 2.0 g in the form of intravenous infusions every 12 hours.	Possible digestive upset, allergies, candidiasis, jaundice.	It is a bactericidal agent against streptococci, E. coli and pneumococci.
Levomycetin	Prescribed at 50-100 mg/kg of body weight daily. The daily dose of the drug is divided into three doses (approximately once every 8 hours).	Sometimes nausea, diarrhea, visual and hearing impairment, and allergies occur.	The drug inhibits the development of shigella, E. coli, and pale treponema.
Meropenem	Prescribed at 2.0 g once every 8 hours.	Abdominal pain, digestive problems, and changes in blood pressure may occur.	The drug inhibits the development of hemolytic streptococcus and Haemophilus influenzae.
Streptomycin	Prescribed in the amount of 1.0 g/day in the form of intramuscular injections.	Kidney pain, hearing loss, drowsiness, and diarrhea may occur.	The drug is active against Mycobacterium tuberculosis, gonococci, Brucella and Klebsiella.

Symptomatic therapy of pachymeningitis consists of the use of diuretics, vitamins, analgesics and drugs to stabilize temperature indicators.

	Method of administration and dosage	Side effects	Special instructions
Furosemide	For cerebral edema, it is prescribed as a jet injection, 80-120 mg, in combination with colloids.	Nausea, diarrhea, decreased blood pressure, dizziness, hypokalemia are possible.	The drug blocks the reabsorption of sodium in the tubules, increasing diuresis.
Vitamins B 1 and B 6	Prescribed as intramuscular injections of 1 ml every day.	Allergies, dizziness, tachycardia are possible.	Vitamins accelerate metabolic processes in brain tissue.
Acetaminophen	Prescribed 1-2 tablets once every 6 hours. The maximum daily dose is 8 tablets.	Allergies may develop.	The drug relieves pain and stabilizes body temperature.
Cordiamine	It is prescribed in the form of intramuscular or intravenous injections, 2 ml up to 3 times a day.	Sometimes there is redness of the face, nausea, and allergies.	The drug improves metabolic processes in brain tissue.

When seizures occur, anticonvulsant drugs are prescribed:

	Method of administration and dosage	Side effects	Special instructions
Phenobarbital	Prescribed 50-100 mg in the morning and evening, orally.	Possible decrease in blood pressure, allergies, CNS depression.	The drug has sedative and anticonvulsant properties.
Aminazine	Prescribed as intramuscular injections, 2 ml.	Convulsions, decreased blood pressure, dyspepsia, and leukopenia may occur.	The drug calms the nervous system.

In case of purulent pachymeningitis, only surgical treatment is prescribed, which consists of trepanation of the skull, removal and excision of the purulent capsule.

Physiotherapy treatment

Physiotherapy is used at the rehabilitation stage of patients with pachymeningitis. Similar treatment:

• improves intracerebral hemodynamics and capillary circulation;
• improves metabolic processes in the brain;
• corrects brain functions in pachymeningitis;
• supports the functioning of the nervous system;
• restores immunity.

Among the immunostimulating procedures, the most popular are high-frequency magnetic therapy, as well as UV rays (especially in an erythemal dose) and electrophoresis with immunomodulators.

Electrosleep sessions, electrophoresis with sedatives and neurostimulators have sedative properties.

Low-intensity UHF therapy and transcerebral UHF therapy are particularly effective.

If it is necessary to expand cerebral vessels, electrophoresis with vasodilators or galvanization is used.

Folk remedies

The recipes offered by traditional medicine can be used after the acute phase of pachymeningitis has been stopped, simultaneously with conservative therapy carried out in a hospital. Such a combination will contribute to the fastest possible recovery of the patient's body.

If the patient complains of severe headaches, convulsions and neurosis, then he is recommended to pay special attention to recipes that include primrose or valerian rhizome, lavender flowers, mint or rosemary leaves.

You can prepare an infusion based on the plants listed above. To do this, mix all the components in the same ratio. Then brew 1 tbsp. of the medicinal mixture in 200-250 ml of water brought to a boil, insist in a thermos for about five hours. Take the medicine for pachymeningitis 100 ml 4 times a day 30 minutes before meals.

Linden blossom, known for its anti-inflammatory, immunomodulatory and analgesic properties, has a good effect. To prepare linden tea, pour 500 ml of boiling water over a quarter of a glass of linden flowers and leave for an hour. Drink this tea before meals, 100-150 ml.

This remedy is also extremely helpful for pachymeningitis: grind 2 teaspoons of poppy seeds in a mortar, mix with 200 ml of milk heated to 70°C and leave in a thermos overnight. Take the medicine three times a day, 1 tablespoon 60 minutes before meals.

The main symptoms of pachymeningitis are well eliminated with the help of infusions of chamomile, cranberry, and rose hips. The duration of treatment with folk remedies depends on the severity of the disease and the general well-being of the patient.

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Herbal treatment

To normalize metabolic processes in the brain after pachymeningitis, traditional healers recommend using plants such as betony, black elderberries, cornflower flowers, silverweed, celery, violet flowers, horsetail, and eryngium.

1. Take equal amounts of violet, green parsley, bearberry, oregano, juniper and adonis. Brew 2 tbsp of the resulting mixture in 1 liter of boiling water, leave for several hours. Filter and take 150 ml three times a day half an hour before meals.
2. Prepare a collection of equal amounts of strawberry leaves, chicory rhizome, St. John's wort, calamus rhizome, rose hips and juniper berries, yarrow. Brew 2 tbsp of the collection in 0.5 l of boiling water, leave for several hours to infuse. Filter and drink 150 ml three times a day, possibly with honey.
3. Prepare a mixture of equal amounts of rosemary leaves, St. John's wort, calendula and elecampane rhizome. Brew 1 tbsp of the mixture in 250 ml of boiling water and leave for two hours. Drink a quarter of a glass in the morning, before lunch and at night for pachymeningitis.

Homeopathy

The use of homeopathy for pachymeningitis causes a lot of controversy and discussion. However, professional homeopathic specialists believe that they can choose an effective drug that will cope with the main symptoms of the disease.

• Apis mellifica is used for pachymeningitis in childhood, in the presence of severe headaches.
• Arnica montana - suitable for the treatment of pachymeningitis that occurs as a result of injury or surgery.
• Belladonna - used for rapid rise in temperature in pachymeningitis.
• Bryonia is prescribed for pachymeningitis, which is accompanied by a disturbance of consciousness and impaired motor coordination.
• Helleborus is used for disorders of consciousness, paresis and physical exhaustion.
• Henbane - helps with severe muscle spasms.

Treatment of pachymeningitis with the listed drugs should be supervised by an experienced homeopathic physician, since this disease is quite serious and requires an individual approach to the patient.

Prevention

The main measures to prevent the development of pachymeningitis are:

• competent and timely elimination of any infectious diseases, and in particular – pathologies of the ear, throat and nasal sinuses;
• correct and timely treatment of purulent lesions, such as acne or boils;
• avoiding contact with people suffering from various forms of meningitis;
• compliance with personal hygiene rules;
• maintaining immunity at a healthy level, hardening, eating high-quality vitamin-rich and varied foods;
• prevention of head and spinal injuries.

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Forecast

Usually, the prognosis depends on how quickly the symptoms of pachymeningitis were detected and how timely and competently the patient was provided with assistance. If the disease was diagnosed at an early stage of development, after which the patient was immediately prescribed treatment, then the further outcome of pachymeningitis can be considered favorable. In advanced cases, complications may arise, up to serious and extremely negative consequences.

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