Meningeal manifestations are often pronounced. Meningeal syndrome: why it occurs and how it manifests itself. Features of the development of the syndrome in children

A combination of subjective and objective neurological disorders caused by irritation of the meninges. Subjective disorders: headache, nausea, general skin hyperesthesia and increased sensitivity to light and sound stimuli. The headache is predominantly diffuse in nature, but can also be localized (usually in the forehead and back of the head); increases with changes in body position and various exogenous influences. Infants and young children may have a sharp, sudden cry during sleep ("hydrocephalic cry"). Often, headaches are accompanied by vomiting, which occurs suddenly and unrelated to food intake, and is sometimes preceded by short-term nausea. After vomiting, headaches often decrease. The characteristic symptoms of M.s. are hyperacusis and photophobia. The slightest touch causes general anxiety and crying in the patient.

Objective neurological disorders in M.s. characterized by the peculiar position of the patient in bed and the presence of various meningeal symptoms. In acute syndrome, the patient usually lies on his side with his head thrown back and his torso elongated, with a retracted “scaphoid” abdomen, his arms bent at the elbow joints and pressed to his chest, with his hips and knees bent and his legs pressed to his stomach (meningeal posture, " pointer dog pose", "cocked gun pose").

The following meningeal symptoms are observed: stiff neck - the inability to bring the patient’s head to the chest due to sudden tension in the extensor muscles of the neck; Kernig's symptom - the inability to passively straighten the leg, previously bent at a right angle at the hip and knee joints (this symptom must be distinguished from Lasegue's symptom - see Radiculitis); Brudzinski's symptom superior - flexion of the legs at the knee and hip joints with passive flexion of the head of the patient lying on his back; Brudzinski's symptom pubis - bending the legs at the knee and hip joints, pulling them towards the stomach while pressing on the pubic symphysis; Brudzinski's symptom lower - an attempt to straighten a leg bent at a right angle at the knee and hip joints leads to bending of the second leg and bringing it to the stomach; Brudzinski's symptom is buccal - when pressing on the cheek below the zygomatic arch, an involuntary lifting of the shoulder girdle and bending of the arms at the elbow joints occurs; Guillain's symptom - compression of the quadriceps muscle of one leg leads to flexion of the knee and hip joints of the other and bringing it to the stomach; Ankylosing spondylitis symptom - with light percussion of the zygomatic arch, the headache intensifies and a painful grimace appears; Bickel's symptom - a feeling of pronounced resistance when trying to straighten the patients' arms, bent at the elbow joints; Bogolepov's symptom - a painful grimace when causing Kernig's symptom or compression of the anterior group of thigh muscles; Levinson's symptom - involuntary opening of the mouth when the patient tries to bend his head to his chest; a symptom of crossed arms - involuntary bending of the legs at the knee and hip joints when crossing the patient's arms on the chest (the same response occurs when trying to sit the patient by the forearms with his arms crossed on the chest - Kholodenko's symptom).

These meningeal symptoms are observed in patients of different age groups (both adults and children). For children with M.s. The following symptoms are especially characteristic: the hanging symptom (Lesage's symptom), when when lifting a child under the armpits, his legs bend at the hip and knee joints, are pulled towards the stomach, remaining in this position for a long time (occurs mainly in infants); Meitus symptom - the doctor is unable to place the child in the position of the child lying on his back with straightened legs, fixing them in the knee joints with one hand, and sitting the child with the other hand lying on his back (when the meninges are irritated, a right angle is formed between the back and straightened legs). According to the mechanism of occurrence and external manifestations, they are partially similar to the last symptom: Fanconi's symptom - the child cannot sit up independently on the bed with the legs straightened and fixed at the knees; tripod (strut) symptom - forced support on the hands behind the buttocks when sitting in bed; symptom of “kissing the knee” - the child cannot touch the knee with his lips even with maximum bending of the legs; "potty" symptom - the child sits on the potty only with his hands supporting him on the floor behind his back.

Infants often experience swelling, tension, and sometimes increased pulsation of the large fontanel (in some cases the leading symptoms).

In addition to these main symptoms, there are other signs caused by irritation of the meninges and reflecting the severity of the patient’s condition: Mondonesi’s symptom (bulbofacial tonic symptom) - contraction of the facial muscles with uniform pressure on the eyeballs (Kuimov’s symptom is somewhat similar - a painful facial reaction with a similar effect); Leuchtenstern's symptom - general shuddering of the patient upon percussion of the frontal bone; Hermann's symptom: 1) extension of the first toes with a passive tilt of the head forward; 2) extension of the first toe when flexing the straightened leg at the hip joint; Flatau's symptom - dilation of the pupils with intense flexion of the patient's head; Edelman's symptom - extension of the first toe when causing Kernig's symptom; Lafora's symptom - pointed facial features; “blanket” symptom - the desire of a patient with impaired consciousness to hold on to the blanket being pulled off him; Strumpel's symptom - extension of the first toe when pressing on the knee joint in a patient lying on his back; Netter's symptom - when pressure is applied to the knee joint of one leg of a patient sitting in bed with legs extended, the other leg bends at the knee and hip joints (determined by mild irritation of the meninges, since with severe MS, such an initial position is impossible); Gurevich-Mann symptom - increased headache when opening the eyes and moving the eyeballs. Some authors consider one of the signs of irritation of the meninges to be pain in the retromandibular region (Signorelli's sign), dilation of the pupils when the skin of the neck is irritated by a pinch (Parro's symptom), asynchrony of the respiratory movements of the diaphragm and chest (Simon's symptom).

In children, irritation of the meninges almost never manifests itself with a “full set” of meningeal symptoms. Usually only a few of them are detected. In addition, with M.s. There is not always a correspondence between the severity of subjective and objective neurological disorders.

If the child has M.s. it is necessary to find out the reasons for its occurrence. This syndrome can occur with inflammation of the meninges (see Meningitis), with episubdural and subdural hematoma, subarachnoid hemorrhage, intracranial hematoma, brain tumor (see), traumatic brain injury (see). The first step in differential diagnosis is the examination of cerebrospinal fluid (see Cerebrospinal fluid).

The detection of pleocytosis indicates meningitis, regardless of the presence and severity of M.s. Uniform staining of the cerebrospinal fluid with blood indicates subarachnoid hemorrhage or rupture of blood into the spaces containing the cerebrospinal fluid. Differential diagnosis of other pathological processes is based on the analysis of clinical data and paraclinical research methods.

Brain diseases are characterized by the presence of specific symptoms, the basis of which is meningeal symptoms. These symptoms are the main evidence of the onset of serious changes in the nervous system, and the sooner the disease is recognized and treatment is started, the greater the chance of recovery without serious consequences.

It is no coincidence that meningeal signs have this name, since in the vast majority of cases the cause of their manifestation is meningitis. Its different forms are characterized by certain symptoms, but the basis is meningeal.

With meningitis, in addition to inflammatory processes in the brain, noticeable changes occur in the cerebrospinal fluid, and this is one of the features of the course of the disease. There are a number of causes that can cause symptoms similar to meningeal syndromes, but do not affect the spinal cord, in particular:

• excessive sunbathing
• excessive saturation of the human body with water (usually occurs after severe dehydration)
• severe infectious diseases (salmonellosis, typhoid, influenza)
• alcohol poisoning
• transient cerebrovascular accident (TCI)
• allergies
• brain tumors
• radioactive damage to the body

All of the above can cause the development of meningeal syndrome, but in this situation the treatment differs from the treatment of meningitis.

In addition, there is such a thing as “pseudomeningeal symptoms,” which occur in some diseases that are not associated with damage to the meninges (mental disorders, osteochondrosis). That is why it is important to take into account all manifestations and make the correct diagnosis.

Classification

It's time to look directly at the symptoms themselves, which are commonly called meningeal. The meningeal symptom complex includes:

a — pointing dog pose, b — Kernig’s sign, c — Brudzinski’s sign

• Kernig's sign
• Brudzinski syndrome
• headache
• vomit
• Bekhterev's symptom
• Gordon's reflex
• Guillain's reflex
• Le Sage syndrome
• stiff neck muscles
• presence of a “pointing dog” pose
• hyperesthesia

To diagnose a syndrome such as Kernig's symptom, the patient is asked to take a supine position, after which the doctor bends his leg at the hip and knee joints at an angle of 90°. Flexion occurs unhindered, but problems arise with extension. So, due to tension in the muscles of the back of the thigh, the patient cannot do this on his own.

Brudzinski syndrome

Brudzinski meningeal syndrome has several variations, including:

1. Buccal.
2. Lower.
3. Upper.
4. Average.

Buccal – the doctor applies pressure to the patient’s cheek, resulting in involuntary flexion of the arms at the elbow joint, as well as a kind of shrug of the shoulders.

Lower - With the patient sitting, one of the legs is bent, the second automatically bends along with the first.

Upper – the patient’s head is tilted forward, and the legs are automatically bent.

Medium – when pressing on the patient’s pubis, the legs bend.

Often, Kernig and Brudzinski syndromes occur together in meningitis.

Headache

When meningitis occurs, headache accompanies the patient constantly and does not stop for a minute. It is one of the most pronounced meningeal symptoms.

Vomit

Gag reflexes can occur in a patient even in the absence of such manifestations as primary symptoms, such as nausea. Vomiting occurs suddenly against the background of a severe headache and is characterized by a gushing outpouring.

In some cases, there is a decrease in the intensity of headaches after bouts of vomiting.

Bechterew's syndrome

Meningeal ankylosing spondylitis is diagnosed by tapping the patient's cheekbone with a finger. This tapping causes a severe headache on the side of the face where there is inflammation, in addition, this side will curl up in a grimace of pain.

Gordon's meningeal syndrome is diagnosed by a neurologist as follows: the doctor wraps his hand around the patient's lower leg and applies strong compression. As a result, the patient's big toe unclenches, and the fingers also diverge in different directions.

Guillain reflex

The patient is asked to take a lying position, after which the doctor applies pressure on the front surface of the thigh of one of the legs or squeezes it. As a result, the opposite leg involuntarily bends at the knee.

Lesage syndrome

This symptom is typical for infants, and in most cases it is diagnosed in them. The patient lifts himself by the armpits above the floor, as a result of which the baby's legs involuntarily tighten (are pulled towards the chest).

Neck muscle stiffness

This condition is characterized by hypertonicity of the occipital and cervical muscles and manifests itself in the inability or difficulty in performing simple actions, such as turning the head or tilting it.

Often, muscle rigidity is characteristic of young children, but not in quality, but due to the fact that the peripheral nervous system is not fully formed. Therefore, it is extremely important to diagnose the disease comprehensively and be based on several factors.

Pointing dog pose

In some sources there is such a name as the “cocked hammer” pose. It manifests itself as follows: the patient throws his head back, the torso is tense and elongated, the arms are pressed tightly to the chest, the legs are also pulled up to the thoracic region.

Hyperesthesia

Meningeal hyperesthesia syndrome, or increased light and noise sensitivity, manifests itself in the form of painful perception by the patient of bright light and loud sounds. For this reason, the patient is recommended to stay in a darkened room and, if possible, completely eliminate irritating sounds.

Features of the course of the disease in children

As for children, at an early age it is difficult to diagnose the disease based on meningeal symptoms, since most of them do not appear.

The main symptom characteristic of children is Le Sage syndrome, as well as a severe headache, against the background of which the child becomes irritable, refuses to eat and develops apathy.

Rare species

Modern neurology, in addition to the above, there are other meningeal syndromes, however, their manifestations are rare, these include:

1. Levinson's sign (opening of the mouth when trying to touch the chin to the chest).
2. Perrault's sign (pupil dilation with any pain).
3. Mendel's sign (pressure on the eyeballs or ears causes pain).

Thus, as soon as meningeal syndrome manifests itself in a patient, the patient must immediately take measures to contact a specialist and begin treatment as soon as possible, since in addition to mild forms of meningitis, there is a possibility of developing acute forms of meningitis, which can be fatal.

The main, most constant and informative signs of irritation of the meninges are stiff neck and Kernig's sign. A doctor of any specialty should know them and be able to identify them. Rigidity of the neck muscles is a consequence of a reflex increase in the tone of the extensor muscles of the head. When checking this symptom, the examiner passively flexes the head of the patient lying on his back, bringing his chin closer to the sternum. In the case of stiff neck muscles, this action cannot be performed due to pronounced tension in the extensor muscles of the head (Fig. 32.1a). An attempt to bend the patient's head can lead to the upper part of the body being raised along with the head, without causing pain, as happens when checking the Neri radicular symptom. In addition, it must be borne in mind that rigidity of the head extensor muscles can also occur with pronounced manifestations of akinetic-rigid syndrome, then it is accompanied by other signs characteristic of parkinsonism. Kernig's symptom, described in 1882 by St. Petersburg infectious disease doctor V.M. Kernig (1840-1917), received well-deserved wide recognition throughout the world. This symptom is checked as follows: the leg of the patient, lying on his back, passively bends at an angle of 90° in the hip and knee joints (the first phase of the study), after which the examiner makes an attempt to straighten this leg at the knee joint (the second phase) . If a patient has meningeal syndrome, it is impossible to straighten his leg at the knee joint due to a reflex increase in the tone of the leg flexor muscles; with meningitis, this symptom is equally positive on both sides (Fig. 32.16). At the same time, it must be borne in mind that if the patient has hemiparesis on the paresis side due to changes in muscle tone, the Kernig sign may be negative. However, in older people, especially if they have muscle stiffness, there may be a misconception of a positive Kernig's sign. Rice. 32.1. Identification of meningeal symptoms: a - stiff neck and upper Brudzinski's sign; b — Kernig’s symptom and lower Brudzinsky’s symptom. Explanation in the text. In addition to the two main meningeal symptoms mentioned, there are a significant number of other symptoms of the same group that can help clarify the syndromic diagnosis. Thus, a possible manifestation of meningeal syndrome is Lafora’s symptom (sharpened facial features of the patient), described by the Spanish doctor G. R. Lafora (born 1886) as an early sign of meningitis. It can be combined with tonic tension of the masticatory muscles (trismus), which is characteristic of severe forms of meningitis, as well as tetanus and some other infectious diseases accompanied by severe general intoxication. A manifestation of severe meningitis is also a peculiar position of the patient, known as the “coping dog” position or the “cocked hammer” position: the patient lies with his head thrown back and his legs pulled up to his stomach. A sign of pronounced meningeal syndrome can also be opisthotonus - tension in the extensor muscles of the spine, leading to tilting of the head and a tendency to hyperextension of the spinal column. With irritation of the meninges, Bickel's symptom is possible, which is characterized by an almost permanent stay of the patient with the forearms bent at the elbow joints, as well as the blanket symptom - a tendency for the patient to hold onto the blanket pulled off from him, which manifests itself in some patients with meningitis even in the presence of altered consciousness. The German doctor O. Leichtenstern (1845-1900) at one time drew attention to the fact that during meningitis, percussion of the frontal bone causes increased headache and general shuddering (Lichtenstern's symptom). Possible signs of meningitis, subarachnoid hemorrhage or cerebrovascular insufficiency in the vertebrobasilar system are increased headache when opening the eyes and when moving the eyeballs, photophobia, tinnitus, indicating irritation of the meninges. This is meningeal Mann-Gurevich syndrome, described by the German neurologist L. Mann (I866-1936) and the domestic psychiatrist M.B. Gurevich (1878-1953). Pressure on the eyeballs, as well as pressure from fingers inserted into the external auditory canals on their anterior wall, is accompanied by severe pain and a painful grimace, caused by a reflex tonic contraction of the facial muscles. In the first case we are talking about a bulbofascial tonic symptom, described during irritation of the meninges by G. Mandonesi, in the second - about Mendel’s meningeal symptom (described as a manifestation of meningitis by the German neurologist K. Mendel (1874-1946). The meningeal zygomatic symptom is widely known Bekhterev (V.M. Bekhterev, 1857-1927): percussion of the zygomatic bone is accompanied by increased headache and tonic tension of the facial muscles (painful grimace) mainly on the same side. You may also be a possible sign of irritation of the meninges - painful pain on deep palpation of the retromandibular points (Signorelli’s symptom), which was described by the Italian doctor A. Signorelli (1876—1952). A sign of irritation of the meninges can also be soreness of Kehrer's points (they were described by the German neurologist F. Kehrer, born in 1883), corresponding to the exit points of the main branches of the trigeminal nerve - supraorbital, in the area of ​​the canine fossa (fossa canina) and chin points, as well as points in the suboccipital region of the neck, corresponding to the exit points of the greater occipital nerves. For the same reason, pain is also possible when pressure is applied to the atlanto-occipital membrane, usually accompanied by suffering facial expressions (Kullenkampf’s symptom, described by the German doctor Kullencampf S, born in 1921). A manifestation of general hyperesthesia, characteristic of irritation of the meninges, can be recognized as dilation of the pupils, sometimes observed during meningitis, with any moderate painful effect (Perrot’s symptom), which was described by the French physiologist J. Parrot (born in 1907), as well as with passive flexion of the head (Flatau’s pupillary symptom), described by the Polish neuropathologist E. Flatau (I869-1932). An attempt by a patient with meningitis to bend his head on instructions so that the chin touches the sternum is sometimes accompanied by opening of the mouth (Levinson's meningeal symptom). Polish neurologist E. Herman described two meningeal symptoms: 1) passive flexion of the head of a patient lying on his back with his legs outstretched causes extension of the big toes; 2) flexion at the hip joint of the leg straightened at the knee joint is accompanied by spontaneous extension of the big toe. Four meningeal symptoms of Brudzinski, also described by the Polish pediatrician J. Brudzinski (1874-I917), became widely known: 1) buccal symptom - when pressing on the cheek under the zygomatic arch on the same side, the shoulder girdle rises, the arm bends at the elbow joint; 2) upper symptom - when trying to bend the head of a patient lying on his back, i.e. when trying to identify stiff neck muscles, his legs involuntarily bend at the hip and knee joints, pulling towards the stomach; 3) middle, or pubic, symptom - when a fist is pressed on the pubis of a patient lying on his back, his legs bend at the hip and knee joints and are pulled towards the stomach; 4) lower symptom - an attempt to straighten the patient’s leg at the knee joint, which was previously bent at the hip and knee joints, i.e. checking the Kernig sign is accompanied by pulling the other leg to the stomach (see Fig. 32.16). Involuntary bending of the legs at the knee joints when the examiner tries to raise the upper part of the body of a patient lying on his back with his arms crossed on his chest is known as Kholodenko’s meningeal symptom (described by Russian neurologist M. I. Kholodenko, 1906-1979). The Austrian doctor N. Weiss (Weiss N., 1851 - 1883) noticed that in cases of meningitis, when Brudzinsky and Kernig's symptoms are caused, spontaneous extension of the 1st toe occurs (Weiss's symptom). Spontaneous extension of the big toe and sometimes a fan-shaped divergence of the remaining toes can also occur when pressing on the knee joint of a patient with meningitis lying on his back with his legs extended - this is Strumpell’s meningeal symptom, which was described by the German neurologist A. Strumpell (1853- 1925). The French neurologist G. Guillain (1876-1961) found that when pressure is placed on the anterior surface of the thigh or compression of the anterior thigh muscles, a patient with meningitis lying on his back involuntarily bends the leg on the other side at the hip and knee joints (Guillain's meningeal sign). Domestic neurologist N.K. Bogolepov (1900-1980) drew attention to the fact that when Guillain’s symptom and sometimes Kernig’s symptom are evoked, the patient experiences a painful grimace (Bogolepov’s meningeal symptom). Extension of the big toe when checking Kernig's symptom as a manifestation of irritation of the meninges (Edelman's symptom) was described by the Austrian physician A. Edelmann (1855-I939). Pressure on the knee joint of a patient sitting in bed with his legs extended causes spontaneous flexion of the knee joint of the other leg - this is Netter's symptom - a possible sign of irritation of the meninges. When fixing the knee joints of a patient lying on his back to the bed, he cannot sit up, since when he tries to do this, the back leans back and an obtuse angle is formed between it and the straightened legs - the meningeal symptom of Meitus. The American surgeon G. Simon (I866-1927) drew attention to a possible disruption of the correlation between the respiratory movements of the chest and diaphragm in patients with meningitis (Simon's meningeal symptom). In patients with meningitis, sometimes after irritation of the skin with a blunt object, pronounced manifestations of red dermographism occur, leading to the formation of red spots (Trousseau's spots). This symptom was described by the French physician A. Trousseau (1801 - 1867) as a manifestation of tuberculous meningitis. Often in the same cases, patients experience tension in the abdominal muscles, causing a retracted abdomen (a symptom of a “scaphoid” abdomen). In the early stage of tuberculous meningitis, the domestic doctor Sirnev described an enlargement of the lymph nodes of the abdominal cavity and the resulting high standing of the diaphragm and manifestations of spasticity of the ascending colon (Syrnev’s symptom). When a child with meningitis sits on the potty, he tends to rest his hands on the floor behind his back (meningeal potty symptom). In such cases, the phenomenon of “kissing the knee” is also positive: if the meninges are irritated, the sick child cannot touch the knee with his lips. For meningitis in children of the first year of life, the French doctor A. Lesage described the symptom of “suspension”: if a healthy child of the first years of life is taken under the arms and raised above the bed, then he “minces” with his legs, as if looking for support. A child suffering from meningitis, finding himself in this position, pulls his legs towards his stomach and fixes them in this position. The French doctor P. Lesage-Abrami noticed that children with meningitis often experience drowsiness, progressive weight loss and cardiac arrhythmias (Lesage-Abrami syndrome). Concluding this chapter, we repeat that if the patient has signs of meningeal syndrome, in order to clarify the diagnosis, a lumbar puncture should be made with determination of liquor pressure and subsequent analysis of CSF. In addition, the patient should undergo a thorough general somatic and neurological examination, and in the future, during the treatment of the patient, systematic monitoring of the therapeutic and neurological status is necessary. CONCLUSION By completing the book, the authors hope that the information presented in it can serve as a basis for mastering the knowledge necessary for a neurologist. However, the book on general neurology offered to your attention should be considered only as an introduction to this discipline. The nervous system ensures the integration of various organs and tissues into a single organism. Therefore, a neurologist is required to have broad erudition. He must be, to one degree or another, oriented in almost all areas of clinical medicine, since he often has to participate in the diagnosis of not only neurological diseases, but also in determining the essence of pathological conditions that doctors of other specialties recognize as beyond their competence . In everyday work, a neurologist must also prove himself as a psychologist who can understand the personal characteristics of his patients and the nature of the exogenous influences affecting them. A neurologist, to a greater extent than doctors of other specialties, is expected to understand the mental state of patients and the characteristics of the social factors influencing them. Communication between a neurologist and a patient should, whenever possible, be combined with elements of psychotherapeutic influence. The scope of interests of a qualified neurologist is very wide. It must be borne in mind that damage to the nervous system is the cause of many pathological conditions, in particular dysfunction of internal organs. At the same time, neurological disorders manifested in a patient are often a consequence, a complication of his existing somatic pathology, common infectious diseases, endogenous and exogenous intoxications, pathological effects on the body of physical factors and many other reasons. Thus, acute disorders of cerebral circulation, in particular strokes, are usually caused by complications of diseases of the cardiovascular system, the treatment of which, before the appearance of neurological disorders, was carried out by cardiologists or general practitioners; chronic renal failure is almost always accompanied by endogenous intoxication, leading to the development of polyneuropathy and encephalopathy; many diseases of the peripheral nervous system are associated with orthopedic pathology, etc. The boundaries of neuroscience as a clinical discipline are blurred. This circumstance requires a special breadth of knowledge from a neurologist. Over time, the desire to improve the diagnosis and treatment of neurological patients has led to a narrow specialization of some neurologists (vascular neurology, neuroinfections, epileptology, Parkinsonology, etc.), as well as to the emergence and development of specialties that occupy a borderline position between neurology and many other medical professions (somatoneurology, neuroendocrinology, neurosurgery, neuroophthalmology, neurootiatry, neuroradiology, neuropsychology, etc.). This contributes to the development of theoretical and clinical neurology and expands the possibilities of providing the most qualified care to neurological patients. However, a narrowed profile of individual neurologists and, even more so, the presence of specialists in disciplines related to neurology are possible only in large clinical and research institutions. As practice shows, every qualified neurologist must have broad erudition, in particular, be oriented in problems that in such institutions are studied and developed by specialists of a narrower profile. Neurology is in a state of development, which is facilitated by achievements in various fields of science and technology, the improvement of sophisticated modern technologies, as well as the successes of specialists in many theoretical and clinical medical professions. All this requires a neurologist to constantly improve the level of knowledge, an in-depth understanding of the morphological, biochemical, physiological, genetic aspects of the pathogenesis of various diseases of the nervous system, and awareness of advances in related theoretical and clinical disciplines. One of the ways to improve the qualifications of a doctor is periodic training in advanced courses, conducted on the basis of the relevant faculties of medical universities. At the same time, independent work with specialized literature, in which one can find answers to many questions that arise in practical activities, is of primary importance. To facilitate the selection of literature that may be useful to a novice neurologist, we have provided a list of some books published in Russian over the past decades. Since it is impossible to embrace the immensity, it does not include all literary sources reflecting the problems that arise for a neurologist in practical work. This list should be considered conditional, indicative, and as necessary it can and should be replenished. It is recommended to pay special attention to new domestic and foreign publications, and it is necessary to monitor not only published monographs, but also journals that relatively quickly bring to the attention of doctors the latest achievements in various fields of medicine. We wish our readers further success in mastering and improving knowledge that will contribute to the improvement of professional qualifications, which will undoubtedly have a positive impact on the effectiveness of work aimed at improving the health of patients.

Meningeal syndrome is a set of symptoms of such a dangerous disease as meningitis, accompanied by inflammation of the meninges. The treatment regimen for the pathology depends on the form of its manifestation and the causes of its occurrence. The syndrome occurs with any type of meningitis.

Concept of meningeal syndrome

The concept of the syndrome includes the following symptoms:

• general cerebral;
• general infectious diseases;
• meningeal.

Along with the listed signs, there is a disturbance in the dynamics of the liquor fluid and pathological changes in the spinal substance.

General cerebral symptoms are the reaction of the central nervous system to inflammatory processes occurring in the membranes of the brain. With any type of meningitis, signs characteristic of infectious diseases are observed.

Meningeal symptoms are manifested by an increased reaction of the sensory organs to external factors, changes in reflex functions and muscle tension.

Causes

The main cause of the syndrome is damage to brain cells by pathogenic microorganisms. There are many infections in which irritation of the lining of the brain occurs, but the composition of the cerebrospinal fluid remains unchanged. This condition is called meningism.

It occurs as a result:

• staying too long Sun;
• overconsumption liquids against the background of its difficult removal from the body;
• post-puncture syndrome;
• infections, occurring in severe form - typhus, salmonellosis, etc.;
• poisoning alcoholic drinks;
• suremia– the presence of toxins in the human blood that are not eliminated by the urinary system;
• acute enphalopathies;
• transit ischemic attacks;
• malignant tumors;
• strong allergic reactions;
• defeats radiation;
• subarchial hemorrhages.

Some pathologies have a clinical picture similar to meningeal syndrome. But these signs are not associated with brain damage. Such symptoms are called "pseudomeningeal". They arise due to damage to the frontal part of the brain, pathologies of the spine and some neurological problems.

The principle of development of meningeal syndrome has not yet been studied. Some scientists believe that the symptoms of Lesage and Kernig are a protective reaction of the body that reduces tension in the roots of the spinal cord, thereby reducing pain.

Others believe that Kernig's sign occurs due to muscle dysfunction caused by abnormal functioning of the brain stem and other parts of the brain.

It is also believed that these signs appear as a result of increased pressure in the cerebrospinal fluid channel. The pathological condition occurs due to increased production of cerebrospinal fluid and toxic poisoning of the membranes of the brain.

Clinical picture

Since meningeal syndrome consists of several types of symptoms, the clinical picture of each of them should be considered separately.

General cerebral symptoms

The main sign of damage to brain structures is headache. Its character, as a rule, is bursting, and the location is unclear. In this case, the patient feels strong pressure on the eyes.

At first, discomfort appears periodically, and then is observed constantly and becomes resistant to taking any painkillers. In the morning, the intensity of attacks may be slightly higher than in the evening.

This can be explained simply - after sleep, when a person has spent a long time in a horizontal position, the outflow of biological fluids from the brain worsens.

After the patient assumes a vertical position, the lymph circulation process is restored, and in turn, the headache decreases.

General cerebral symptoms also include:

1. Vomiting and nausea. This condition with meningitis is easy to distinguish from similar signs in case of poisoning or gastrointestinal pathologies. Vomiting with brain damage is not associated with food intake and often occurs in the morning, when a person’s stomach is empty. Nausea with headaches occurs almost constantly. At the same time, there is no feeling of discomfort and bloating in the abdomen, and appetite is not disturbed.
2. Dizziness. The condition is caused by increased pressure inside the skull and obstructed blood supply to the brain. With meningitis, it does not have any features that distinguish it from dizziness in other pathologies.
3. Problems with vision- necessarily appear when brain function is disrupted. They make themselves known in the later stages of meningitis, when tumor processes cover most of the organ.
4. Violation psyche, as a consequence of increased intracranial pressure. Initially, the symptom makes itself felt by loss of memory and attention. Patients become distracted, unable to concentrate on any task. As the tumor progresses and hypertension increases inside the skull, other oddities in human behavior appear - increased aggressiveness, euphoria, “ridiculous” jokes.

1/3 of patients with meningitis experience epileptic seizures. The condition tends to recur from time to time. This sign is considered the most unfavorable and dangerous of all the symptoms of damage to brain structures.

General infectious diseases complex

Symptoms of a general infectious complex include:

• increased body temperature;
• feverish condition;
• feeling of chills;
• spasm of the muscles of the epidermis;
• weakness;
• skin rash.

Any skin rashes at elevated body temperature may indicate the development of meningococcal infection. In 40% of cases, the rash is hemorrhagic in nature and manifests itself in the form of small subcutaneous hemorrhages that look like stars.

Meningeal symptoms

The presence of meningeal symptoms allows us to talk about the development of infection in the human body. If they appear together with general cerebral and general infectious signs, then the diagnosis is considered reliably established. Detailed characteristics of the most common signs of meningeal symptoms are presented in the table.

Not all of these signs appear simultaneously during infection. They can be masked behind general infectious or general cerebral symptoms of pathology. When the patient loses consciousness, many of the above symptoms lose their significance. The main feature of the meningeal clinical picture is a sharp deterioration of the condition.

Signs of pathology largely depend on the type of microorganism that has entered the membranes of the brain. But even all three groups of symptoms are sometimes not enough to make a final diagnosis. Therefore, if an infection is suspected, the doctor prescribes a laboratory test of the cerebrospinal fluid for the patient.

Features of the development of the syndrome in children

In children, meningitis occurs with some features:

1. General infectious diseases signs - a sharp rise in temperature, tachycardia, loss of appetite. At the same time, the child’s skin becomes paler, and hemorrhagic rashes often appear on its surface. Nonspecific signs of infection may also be observed - renal or respiratory failure, severe stool upset.
2. General cerebral syndrome - characterized by severe headaches, vomiting and impaired consciousness. When the disease occurs, children often experience convulsions, the intensity of which can vary from slight twitching of individual muscles to attacks of epilepsy.
3. Meningeal symptoms are most typical for sick children. A child affected by infection assumes the “cocked position” - lying on his side with his head thrown back and limbs bent. Due to increased pressure inside the skull, infants experience protrusion of the fontanel and protruding veins on the eyelids and head.

Purulent meningitis in children can progress with the addition of secondary forms of infection - sepsis, pneumonia, arthritis. The most serious consequences of the pathology are complete impairment of intelligence, paralysis of the limbs, damage to the facial nerves.

Diagnosis of the syndrome

To determine meningitis, specialists resort to the following diagnostic methods:

1. Anamnesis. The patient is diagnosed with chronic diseases and infectious pathologies suffered in the recent past.
2. Visual inspection. It includes a consultation with a neurologist, analysis of the somatic condition (pulse, skin condition, blood pressure), examination of the mucous membranes of the nasopharynx and oral cavity.
3. Laboratory analysis. The most important test to detect meningitis is a lumbar puncture to further analyze the cerebrospinal fluid.
4. Instrumental tests - MRI or CT, x-ray of the skull, echoencephaloscopy.

With purulent meningeal syndrome, turbidity of the CSF is noted. The analysis shows a high content of neutrophils in the substance and an overestimated number of cells. In the serous type of the disease, the CSF is transparent and consists predominantly of lymphocytes.

Cytosis in this case is 200-300 cells per 1 μl. To make the examination results more reliable, the procedure is repeated 8-12 hours after the lumbar puncture.

Therapy

There are still many deaths from bacterial meningitis. Treatment is complicated by the clinical picture that is not always clear. Children may not show many signs of infection

The treatment algorithm for meningeal syndrome in adults and children is as follows:

1. Hospitalization patient to a medical facility.
2. Definition causes development of the disease.
3. Carrying out lumbar punctures in the absence of prohibitions on the procedure.
4. Purpose drugs according to the cause of meningitis and test results.

The basis of treating an infection is eliminating its symptoms and fighting the causative agent of the disease. To do this, the doctor prescribes to the patient:

• antibiotics;
• painkillers;
• B vitamins;
• detoxification agents;
• anticonvulsants;
• hormone therapy;
• dehydration measures.

When intracranial pressure increases to critical levels, cerebrospinal fluid is pumped out. Before the patient is admitted to the hospital, he must be given first aid - to support the functioning of the lungs and heart, reduce the intensity of pain symptoms and temperature, and eliminate the urge to vomit. With the rapid progression of meningitis, the patient is given the first dose of antimicrobial drugs.

To reduce intracranial pressure, Lasix or Dexamethasone is administered intravenously; in severe forms of the disease, Mannitol is administered. If the patient has symptoms of infectious-toxic shock, then a solution of sodium chloride or Polyglucin is administered intravenously along with vasopressors.

Meningeal syndrome cannot occur without cause; some factors influencing its development lead the patient to death. Therefore, if signs of meningeal syndrome are detected, you should immediately consult a doctor. Self-medication of infection is unacceptable.

Content

Meningitis is a demyelinating disease of the nervous system, leading to the destruction of the myelin sheath of neurons. Treatment at home is prohibited. It is important to identify symptoms promptly and get immediate medical help. The difficulty of diagnosis lies in the identity of the symptoms of the disease with the flu. A common form of the disease is bacterial meningitis. It does not destroy the body, but weakens it. If you notice the following symptoms, consult a doctor immediately.

What are the meningeal signs and symptoms?

The disease occurs in two forms: viral and bacterial. Depending on the type, patients exhibit characteristic symptoms. The main meningeal symptoms in adults:

• severe weakness in children and adults;
• temperature rise to 39 degrees;
• aches, especially in the lumbar region;
• irregular breathing rhythm, increased heart rate;
• Blood clots may appear.

Meningeal symptoms in children are as follows:

• severe headache radiating to the neck and back;
• vomiting due to unbearable headaches;
• increased sensitivity to touch;
• convulsions, hyperesthesia;
• Pointer dog pose is a meningeal symptom of the development of a severe form of the disease.

Doctors combine all these symptoms into one syndrome. The combination of signs of the disease is individual for each patient. The main and most common irritations of the meninges are considered to be stiff neck, Kernig's sign. The incubation period of the disease is 2-10 days. The disease is accompanied by accompanying signals that often mislead doctors. Diagnosis is carried out during hospitalization of the patient. Treatment includes tonic measures aimed at strengthening the body.

Test in the Romberg pose

A simple diagnostic test - the Romberg test - reveals dysfunction of organ systems that are involved in maintaining balance. These include: the vestibular apparatus, the proprioception system (deep sensitivity), and the cerebral functions of the cerebral cortex. Conduct: the patient stands straight, legs together, with eyes closed, stretches his arms forward. Swaying, deviation to the right or left, etc. indicate damage to the cerebellum, neurological abnormalities.

Kernig's sign

One of the important signs of a disorder of the meninges is the Kernig sign. Named in honor of the Russian therapist V.M. Kernig. Method of implementation: the patient, lying on his back, bends his leg at the joints 90 degrees. Next, the doctor attempts to straighten the leg. With meningitis this cannot be done. The analysis is positive to an equal extent on both sides of the test. Occurs in the early stages of meningitis.

Babinski reflex and asynergia

Babinsky's asynergy is performed as follows: the patient lying on his back is crossed with his arms and asked to sit down. On the affected side, the patient's lower limbs rise. Another interpretation: when pushing back or falling, the patient with damage to the cerebellum falls backward. There is no bending of the knee joints to maintain balance. Asynergia – indicates difficulties in performing combined movements. Occurs at the initial stage of development of meningitis and other diseases.

Brudzinski's sign

The combination of signs resulting from brain damage is Brudzinski’s symptom. Occurs in several diseases at once. The following types are distinguished:

• Upper. It manifests itself as involuntary bending of the legs, pulling towards the stomach while hanging (lowering) the head down.
• Average. When pressure is applied to the pubis, the legs bend.
• Lower. When checking, a Kerning symptom is revealed on one side, on the other - the leg, bending, is pulled towards the stomach.
• Buccal. When you press on the zygomatic arch, your shoulders rise and your arms bend.

Muscle stiffness

It appears in almost 80% of cases. Indicates irritation of the membranes of the brain, disorders of the central nervous system. Rigidity of the neck muscles is determined with the patient in a supine position. When passively bending the head, tension occurs in the muscles of the neck and occipital muscles. They prevent the chin from moving towards the chest. Muscular rigidity of the cervical spine is often accompanied by tightness of the muscles of the back and limbs. False rigidity also occurs in the presence of spondyloarthrosis, spondylosis of the cervical spine.

Rossolimo's symptom

The finger reflex is caused by striking the fingers on the phalanges of the 2-5 toes of the patient's foot. The patient's reaction is to flex the soles or, in rare cases, abduct them. The patient is examined in a lying position. All fingers or 2 and 5, one thumb can participate in the movement. Healthy individuals have no symptoms. The symptom is a pathological flexion type, manifested when the pyramidal tract is damaged. Second option: the symptom is determined on the patient’s hands.

Oppenheim's sign

During the analysis, extension of the big toe is observed during irritation of the medial surface of the leg. Method of implementation: the doctor uses the phalanx of the thumb or index finger to forcefully carry out sliding movements from top to bottom along the medial surface of the leg. The norm is to bend the fingers. With meningitis, extension of the toes occurs with a slight turn of the foot. Oppenheim's sign is similar to Babinski's reflex. The reflex occurs in most lesions of cerebral activity.

Video about meningeal symptoms

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.