Pachymeningitis

As you know, the human brain consists of several shells - it is a solid, vascular and arachnoid shells, 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 a hard shell, which in medical circles is called "pachymeningitis."

[1], [2], [3], [4],

Epidemiology

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

Outbreaks of the disease are diagnosed mainly in the spring-autumn period, which may be due to sudden temperature fluctuations, epidemics of infectious diseases, a decrease in immune protection in the population and seasonal vitamin deficiency.

The bacterial variant of pachymeningitis is mostly found in countries with a hot climate, as well as in countries with a low level of health development.

[5], [6], [7], [8], [9]

Causes of the pachymeningitis

Speaking of pachymeningitis, usually refer to the inflammatory process, affecting the hard shell of the brain or spinal cord (respectively, cerebral or spinal pachymeningitis).

• Taking into account the layer-by-layer inflammatory lesion of the hard shell, internal and external pachymeningitis is isolated.
• By the type of inflammatory changes pachymeningitis can be serous, purulent and hemorrhagic, and by the nature of the process - acute or chronic.

Serous pachymeningitis occurs due to various infections, poisoning and allergic processes.

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

Purulent pachymeningitis occurs when infectious pathogens come into the cranial cavity from other foci - for example, in otitis, sinusitis, carbuncles or furuncles.

[10], [11], [12]

Risk factors

Factors that increase the risk of pachymeningitis:

• childhood;
• any infectious pathology;
• weakened immunity;
• work with people, frequent stays in public places (especially during epidemics);
• frequent long-distance trips, especially to exotic countries (for example, to African countries);
• head trauma and brain surgery.

[13], [14],

Pathogenesis

Pachymeningitis can occur in several ways:

• hematogenous way, through the lymph, placenta or on the nerve cases;
• contact, in the presence of purulent process in the nasal sinuses, middle ear or mastoid process, with infectious diseases of the teeth or eyes;
• with trauma to the head or spine.

The pathogenetic mechanism is expressed in the friability, edema, and fullness of the dura mater. If the disease is hemorrhagic, then there is impregnation with blood and delamination of the hard shell, as a result of vascular damage. Blood can accumulate in separate cavities, with the formation of gigrom.

With purulent pachymenitis, spikes, extradural and subdural abscesses are formed. With the attenuation of a painful process, enveloped fibrosis is formed.

The chronic process proceeds with the phenomena of fibrosis, followed by densification of the tissues and compression of the nerve endings, which can lead to nerve atrophy.

[15], [16], [17], [18], [19], [20]

Symptoms of the pachymeningitis

Serous pachymeningitis often occurs without any symptoms, so it is detected accidentally.

Hemorrhagic pachymeningitis manifests itself in a variety of clinical signs, although minor hemorrhages may also occur asymptomatically. During an exacerbation there is a pain in the head, which increases, complicated by attacks of vomiting, dizziness and loss of consciousness. Signs such as memory impairment, general indifference, or, on the contrary, an overly excited state, can attract attention.

The first signs depend on the specific location of the focus. There may be minor meningeal manifestations. In some patients, stagnant nipples of the optic nerves, or inflammation of the optic nerve are determined. With a lumbar puncture, the liquor leaves under pressure. It can detect an increased level of protein.

External pachymeningitis begins with localized pain in the head. When tapping the cranium, you can see the pain on the side of the lesion. Pachymeningitis on the background of an extradural abscess is characterized by a severe headache in the zone of the temples. The condition can be accompanied by convulsive attacks, aphasia, numbness of the extremities.

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

With internal purulent pachymeningitis, body temperature values reach 38-40 ° C, chills appear, debilitating pain in the head with vomiting. Often there is detachment, a sense of fatigue, delirium, cramps.

Stages

The course of pachymeningitis can be divided into three stages:

1. The edema stage is accompanied by an agitated or apathetic condition, severe pain in the head, nausea, digestive disorders, seizures, the appearance of pathological reflexes.
2. The stage of diffuse inhibition proceeds with obvious signs of CNS depression. There is indifference, drowsiness, pain in the head becomes less obvious, the temperature stabilizes.
3. The paralytic stage is characterized by the resumption of headaches, fever, tachycardia, darkening of consciousness. Such a stage can be equated to a precomatous state.

[21], [22], [23]

Complications and consequences

Possible development of a number of complications: deterioration of hearing and vision, epilepsy, intellectual disorders, sepsis, astheno-neurotic syndrome.

With weakened immune defense, kidney function, adrenal pathology, and cardiovascular disorders may develop.

With the spread of infection, generalized meningitis can occur, which is characterized by extremely severe course. Often a patient dies from intoxication, toxic shock and massive intracerebral hemorrhages.

If the patient has turned to a doctor in a timely manner, as a result of which pachymeningitis has been completely cured, in some cases, residual effects of the disease can be preserved which are expressed:

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

With such complications, additional treatment is carried out, which is time-consuming and requires an individual approach.

[24], [25], [26], [27], [28], [29], [30]

Diagnostics of the pachymeningitis

Diagnostic procedures for suspected pachymeningitis include interrogation and neurological tests, as well as laboratory tests and instrumental examinations.

Analyzes for pachymeningitis:

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

Instrumental diagnosis of pachymeningitis:

• Cerebrospinal puncture with a fluid intake for examination;
• electroencephalography with recording of brain electrical activity;
• computed tomography with layered examination of brain structures.

[31], [32], [33], [34]

Differential diagnosis

Differential diagnosis is carried out with the ingress of blood into the subarachnoid space, with intracerebral stroke, with tumor and purulent pathologies in the brain, with cerebral arachnoiditis.

[35], [36], [37],

Treatment of the pachymeningitis

Independently at home pachymeningitis can not be treated: the patient must necessarily go to the hospital.

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

	Dosing and Administration	Side effects	Special instructions
Ceftriaxone	Assign to 2.0 g as an intravenous infusion, every 12 hours.	Perhaps a digestive disorder, an allergy, candidiasis, jaundice.	It is a bactericidal agent against streptococci, Escherichia coli and pneumococci.
Levomycetin	Assign 50-100 mg / kg of body weight daily. The daily amount of the drug is divided into three doses (approximately once every 8 hours).	Sometimes there is nausea, diarrhea, visual and hearing impairment, allergies.	The drug depresses the development of shigella, E. Coli, pale treponema.
Meropenem	Assign to 2.0 g once every 8 hours.	Possible abdominal pain, digestive disorders, changes in blood pressure.	The drug inhibits the development of hemolytic streptococcus and hemophilic rod.
Streptomycin	Assign in an amount of 1.0 g / day as intramuscular injections.	There may be kidney pain, hearing loss, drowsiness, diarrhea.	The drug is active against mycobacteria tuberculosis, gonococci, brucella and klebsiella.

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

	Dosing and Administration	Side effects	Special instructions
Furosemide	When cerebral edema is prescribed as a jet injection, 80-120 mg, in combination with colloids.	Possible nausea, diarrhea, lower blood pressure, dizziness, hypokalemia.	The drug blocks the inverse absorption of sodium in the tubules, increasing diuresis.
Vitamins B 1  and B 6	Assign intramuscular injections of 1 ml every day.	Possible allergies, dizziness, tachycardia.	Vitamins accelerate metabolic processes in the brain tissues.
Acetaminophen	Assign 1-2 tablets once every 6 hours. The maximum daily dose is 8 tablets.	Allergies can develop.	The drug eliminates pain and stabilizes body temperature.
Cordiamine	Assign in the form of intramuscular or intravenous injection, 2 ml up to 3 times a day.	Sometimes there is redness of the face, nausea, allergy.	The drug improves metabolic processes in the brain tissues.

When there are seizures, anticonvulsants are prescribed:

	Dosing and Administration	Side effects	Special instructions
Phenobarbital	Assign 50-100 mg in the morning and evening, inside.	Possible lowering of blood pressure, allergy, CNS depression.	The drug has a sedative and anticonvulsant property.
Aminazine	Assign in the form of intramuscular injections, 2 ml each.	Cramps, lowering of blood pressure, dyspepsia, and leukopenia may occur.	The drug calms the nervous system.

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

Physiotherapeutic treatment

Fizprotsedury used at the stage of rehabilitation of patients with pachymeningitis. Such treatment:

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

Among immunostimulating procedures, high-frequency magnetotherapy, as well as SUF-rays (especially in the erythematous dose) and electrophoresis with immunomodulators are most popular.

Sedation properties are electrosleep sessions, electrophoresis with sedatives and neurostimulants.

Low-intensity DMV-therapy and transcerebral UHF-therapy are especially effective.

If it is necessary to expand the cerebral vessels, electrophoresis with vasodilating agents or galvanization is used.

Alternative treatment

The recipes offered by alternative medicine can be used after the acute phase of pachymeningitis has been relieved, simultaneously with conservative therapy conducted in the hospital. This combination will facilitate the fastest recovery of the patient's body.

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

You can prepare an infusion based on the above plants. To do this, all components are mixed in the same ratio. Then 1 tbsp. L. The medicinal mixture is brewed in 200-250 ml boiling water, insisted in a thermos for about five hours. Take medicine for pachymeningitis 100 ml 4 times a day for 30 minutes before meals.

Good action has a lime-colored color, known for its anti-inflammatory, immunomodulating and analgesic abilities. To make lime tea, pour a quarter of a glass of lime flowers 500 ml of boiling water, insist for an hour. Drink tea before eating for 100-150 ml.

Huge benefit with pachymeningitis and has such a tool: grind in a mortar 2 tsp. Poppy seeds, mixed with 200 ml of warmed to 70 ° C milk and insisted in a thermos bottle overnight. The medicine is taken three times a day for 1 tbsp. L. For 60 minutes before a meal.

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

[38], [39], [40], [41]

Herbal Treatment

To normalize the metabolic processes in the brain after pachymeningitis, alternative healers recommend the use of plants such as a letter, black elderberry, flowers of a cornflower, goose goatee, celery, flowers of violets, horsetail, and a blue-head.

1. Take the same amount of violets, green parts of parsley, bearberry, oregano, juniper and goricveta. Brewed 2 tbsp. L. Collected in 1 liter of boiling water, left for several hours. Filter and take 150 ml three times a day for half an hour before meals.
2. Prepare a collection of the same number of strawberry leaves, rhizomes chicory, St. John's wort, rhizome of ayr, wild rose and juniper berries, yarrow. Brewed 2 tbsp. L. Collecting in 0.5 liters of boiling water, leave for several hours to infuse. Filter and drink 150 ml three times a day, you can with honey.
3. Prepare a collection of the same number of leaves of rosemary, St. John's wort, calendula and rhizome elecampane. Brewed 1 tbsp. L. Collecting in 250 ml of boiling water, is insisted for two hours. Drink at pahimeniigite for a quarter of a glass in the morning, before dinner and at night.

Homeopathy

The use of homeopathy in pachymeningitis causes a lot of controversy and discussion. Nevertheless, professional specialists in homeopathy believe that it is quite possible to select an effective drug that will cope with the main symptoms of the disease.

• Apis mellifika - is used for pachymeningitis in childhood, in the presence of severe pain in the head.
• Arnica Montana - suitable for the treatment of pachymeningitis, which appeared as a result of trauma or surgical intervention.
• Belladonna - used with a rapid rise in temperature with pachymeningitis.
• Bryonia is prescribed for pachymeningitis, which is accompanied by a disorder of consciousness, impaired motor coordination.
• Helleborus - is used for disorders of consciousness, paresis and physical exhaustion.
• Belen - helps with strong spasms of musulature.

The treatment of pachymeningitis with listed drugs should be controlled by an experienced homeopathic doctor, as this disease is serious enough 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 foci - for example, acne or boils;
• avoidance of contact with people who suffer from various forms of meningitis;
• compliance with personal hygiene;
• maintenance of immunity at a healthy level, hardening, the use of quality vitaminized and varied food;
• prevention of head and spine injuries.

[42], [43], [44], [45], [46],

Forecast

Usually the forecast depends on how quickly the symptoms of pachymeningitis were detected, and how timely and competently the patient was treated. If the disease was diagnosed at the initial stage of development, then immediately the patient was prescribed treatment, then the further outcome of pachymeningitis can be considered favorable. In advanced cases, complications can occur, including serious and extremely negative consequences.

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