Meningitis: symptoms in adults

Meningitis - an acute infectious disease, consisting in the defeat of the soft shell of the brain and spinal cord. Meningitis is accompanied by inflammatory changes in cerebrospinal fluid, cerebrospinal fluid. Only a century ago this diagnosis sounded like a verdict. Today, although it is a serious illness of the nervous system, it is almost always curable. Sometimes the presence of meningitis can be indicated only by minor changes in the state of health, but more often than not, severe symptoms cause the patient to immediately seek medical help.

In adults, this ailment is less common than in children, but the symptoms are somewhat different from manifestations of meningitis in childhood. Let's talk about the symptoms in adults in this article.

Functions of the pia mater

The soft medulla is a thin layer of connective tissue that covers the entire surface of the brain and spinal cord. It has several main functions:

• contains blood vessels that feed the brain;
• participates in the circulation of cerebrospinal fluid washing the brain;
• protects brain tissue from infectious and toxic effects.

Causes and classification of meningitis

The cause of inflammation of the meninges can be meningococcal infection.

Since meningitis is an infectious disease, pathogens can be:

• bacteria: the most diverse, often pneumococcus, meningococci, tubercle bacillus;
• viruses: enteroviruses, adenoviruses, influenza and parainfluenza viruses, measles, rubella, herpes of Epstein-Barra, cytomegalovirus;
• fungi: candida, cryptococci;
• protozoa: toxoplasma, malarial plasmodium, mycoplasma, chlamydia, helminths, and others.

Of course, the first two groups of pathogens cause disease in 95% of cases. The entrance gate for infection is most often the nasopharynx, bronchi and intestines. Of these organs, viruses and bacteria with blood flow enter the soft dura mater. Much less often meningitis develops when an infection through the wound occurs with injuries to the brain or spinal cord.

Meningitis are:

• primary: when there is no mention of a common infection or disease of any organ in the history of the disease;
• secondary: if meningitis is the result (complication) of any disease.

By changing the cerebrospinal fluid (cerebrospinal fluid), meningitis is divided into:

• serous: if lymphocytes predominate in the cerebrospinal fluid;
• purulent: if the cerebrospinal fluid predominates in the cerebrospinal fluid.

Serous meningitis is usually caused by viruses, and purulent - by bacteria.

The rate of development of the inflammatory process can be:

• lightening (especially characteristic of meningococcus);
• sharp;
• subacute;
• chronic;
• recurrent.

In terms of severity, meningitis is divided into:

• lungs;
• of moderate severity;
• heavy;
• extremely heavy.

Symptoms

Headache with meningitis is bursting and accompanied by nausea and vomiting.

All the symptoms of meningitis can be divided into three groups:

• general infectious;
• cerebral;
• meningeal.

Common infectious symptomsnonspecific, i.e. their presence does not at all indicate a meningitis. These signs only indicate a possible infectious onset of the disease.

These include: general malaise, fever or chills, muscle pains, joint pains, catarrhal symptoms in the form of a cold, redness of the throat, sneezing, etc., fever, appearance rashes, reddening of the face, palpitations and breathing, enlarged lymph nodes, blood changes, characteristic for infection (increased ESR, increase in the number of leukocytes).

General cerebral symptomsinclude headache, vomiting, frustration, generalized convulsive seizures, stagnant phenomena on the fundus.

Headache with meningitis is bursting, it extends to the entire head, a person experiences pressure from the inside of the eye. The source of the headache is irritation of the meninges, increased intracranial pressure as a result of inflammation. A characteristic feature of headache with meningitis is the occurrence of vomiting on the peak of pain without previous nausea. Vomiting does not bring relief and can be repeated many times. Such a vomiting is called "cerebral".

The presence of consciousness disorders depends on the severity of meningitis. Consciousness can not be disturbed in mild forms. In severe meningitis, quantitative (stunning, coexisting, coma) and qualitative (hallucinations, delusions, psychomotor agitation, onyeroid) disorders of consciousness are observed.

Seizures occur due to irritation of the meninges and increased intracranial pressure. Sometimes the epileptic seizure develops suddenly, against the background of the absence of other symptoms of meningitis.

The cerebral symptoms are also not specific for meningitis.

Meningeal symptoms- this is a special clinical signs of damage to the membranes of the brain. The detected one or two symptoms individually do not confirm the diagnosis of meningitis, since they can develop in other diseases of the nervous system (for example, with subarachnoid hemorrhage). However, the presence of a complex of such symptoms in one patient makes it possible to assume with sufficient certainty the presence of meningitis. And if the patient simultaneously with meningeal revealed both general infectious and cerebral symptoms, the preliminary diagnosis can be considered established.

The meningeal symptoms include:

• general hyperesthesia: increased sensitivity of the skin and sensory organs. The patient is uncomfortable with the slightest touch, he tries to retire to protect himself from sounds, bright light;
• symptom of "blankets" - a consequence of general hyperesthesia. The patient can take cover with the head, lie wrapped even in a warm room. If even a change in consciousness is observed and the patient does not follow the instructions, then the blanket still retains and counteracts its contraction;
• rigidity of the occipital muscles (neck muscles): if you try to bend your head to the chest during the examination, then a healthy person does not feel resistance to this action, and the chin almost touches the chest. When meningitis because of the reflex tension of the neck muscles with passive bending of the head, resistance to movement is felt, and the chin does not reach the chest for several fingers. It should be borne in mind that, in the presence of a concomitant pathology of the spine and the limitation of mobility in it, this symptom is not informative. Sometimes the stiffness of the occipital muscles is so pronounced that the head of the patient in a calm state is thrown back and as it were "drowned" in the pillow;
• meningic posture (posture of a "dog" dog): because of the reflex tension of individual muscle groups, the spine is arched, the head is thrown backward, the legs are pressed to the stomach;
• a symptom of the "navicular" abdomen: the stomach is drawn inward involuntarily. Some doctors consider this symptom to be an integral part of the meningic posture;
• symptoms of Brudzinsky, there are only four of them: cheek - with pressure on the cheek above the cheekbone on the same side of the body, the arm at the elbow bends, the shoulder rises; Upper Brudzinski - when the examiner tries to tilt the head forward, the patient involuntarily bends his legs and pulls up to the stomach; average Brudzinsky - with pressure on the pubis also legs are bent; the lower Brudzinsky - if you bend and press one leg of the patient to the stomach, the second involuntarily also slightly bends;
• Symptom Kernig - the most famous among all meningeal symptoms. For his research, the patient lying on the back passively flexes the leg in the hip and knee joints, and then tries to unbend it in the knee. With meningitis, this can not be done, so the muscles of the leg are straining. This symptom was first described by the Russian scientist Vladimir Mikhailovich Kernig in 1882, his diagnostic significance was immediately appreciated at the international congress of doctors;
• zygomatic meningeal symptom Bechterew: when tapping on the cheekbone, there is a contraction of the facial muscles on the same side and a painful grimace due to the increased headache;
• a symptom of Mendel: when pressing a finger on the front wall of the external auditory canal, the headache sharply increases;
• a symptom of Kerer: when you press your finger on the exit points on the face of the branches of the trigeminal nerve (supraorbital, infraorbital, chin holes), pain is felt;
• a meningeal symptom of Herman: with a passive tilt of the head forward, the patient with the legs straightened on the back has an extension of the big toe. There is also a second variant of this symptom: with a passive flexion in the hip joint of the straightened leg, the big toe is extended;
• Gordon's symptom: when the arm of the lower leg is squeezed, the big toe is extended;
• Guen's meningeal symptom: when the hand of the muscles of the front surface of the thigh of one leg contracts, the other leg involuntarily bends;
• Lafor's symptom: sharpened facial features;
• pupillary symptom Flatau: with a passive tilt of the head forward, there is an expansion of the pupils;
• Bogolepov's symptom: a painful grimace in a patient when testing the symptom of Kernig and Guillain (even with a disturbance of consciousness);
• Bikkel's symptom: it is necessary to ask the patient to bend his hands in the elbows and not to counteract the movements of the doctor. When you try to unbend your hands, the doctor feels resistance, and you can not straighten your arms;
• symptom Mandanesi: when pressing on the eyeballs there is a strain on the muscles of the face;
• Levinson's symptom: when you try to tilt your head forward, your mouth opens.

It should be borne in mind that not all described meningeal symptoms are observed simultaneously. Their appearance can "hide" behind cerebral and general infectious symptoms. With a disturbance of consciousness, many of them lose their significance. A feature of meningeal symptoms is their dynamism. This means that they can appear for a small period of time. For example, during a primary examination of a patient in the admission department, the doctor did not detect any meningeal symptoms, and a couple of hours later they were re-examined.

The clinical picture of meningitis largely depends on the causative agent of the disease. For example, signs of meningitis in combination with hemorrhagic rash throughout the body are characteristic of meningococcal infection. This helps in the diagnosis and administration of so-called etiotropic treatment (ie, specific for this infectious agent).

Of course, all three groups of symptoms, characteristic of meningitis, are still not enough for an accurate diagnosis. They only allow to suspect this disease. For confirmation, it is necessary to carry out a diagnostic lumbar (spinal) puncture followed by a laboratory examination of the resulting material.

Diagnostics

Diagnostic lumbar puncture is a reliable method of diagnosing meningitis. It allows to solve the problem, whether there is an infectious process in cerebrospinal fluid, and, hence, in the mild cerebral membrane. Puncture is performed only in a hospital.

The patient is laid on his side with legs clamped to the abdomen and with the maximum bent head. Puncture is performed between the spinous processes of the 3rd and 4th lumbar vertebrae. After treatment with disinfection solution and local anesthesia, a special puncture needle is punctured into the depth in a certain direction. At the moment of getting into the subarachnoid space, the feeling of resistance to the movement of the needle stops, it seems to "fall through". After that, the inner part (mandraine) is removed from the needle. There is a spinal fluid flowing by drop. Liquored is collected in a sterile test tube and sent to a laboratory. The laboratory doctor determines the quantitative and qualitative parameters of the cerebrospinal fluid. They are compared with normal values ​​and conclude on the nature of the pathological process.

Normally, the liquor is sterile, clear and colorless, contains in 1 μl up to 5 blood cells (all lymphocytes and not more than one neutrophil), the protein content is 0.2-0.33 g / l, and the sugar - half of the content in the blood.

Changes in cerebrospinal fluid with meningitis are in turbidity of the CSF, the appearance of staining, an increase in the content blood cells (neutrophils and lymphocytes), increased protein content, changes in glucose concentration. With purulent and serous meningitis, these changes are significantly different, which is used in diagnosis.

With serous meningitis, the number of cells increases tens of times, the protein rises slightly. Among the cellular elements, lymphocytes predominate. The cerebrospinal fluid usually remains transparent or opalescent (has a shade of mother-of-pearl when viewed through the lumen).

With purulent meningitis, the number of cells increases by hundreds, thousands of times, protein significantly increases. Among the cellular elements, neutrophils predominate. The liquor itself is muddy, becoming yellow-green, dense. For purulent meningitis is characterized by a sharp decrease in the level of glucose. In addition, the sugar content drops sharply in tuberculosis and fungal meningitis.

Such a study of cerebrospinal fluid refers to simple laboratory methods, which are possible in any hospital.

In addition, in order to find the infectious agent that caused meningitis, the cerebrospinal fluid is "sown" to the nutrient medium. Growing columns of microorganisms are identified, their sensitivity to antibiotics is determined, which allows for more precise selection of treatment. However, for the growth of microorganisms, time is required, usually about a week. Sometimes the patient does not have the opportunity to wait so long for the result. In such cases, in order to quickly determine the causative agent of meningitis, it is possible to conduct immunological express methods: method of oncoming immunophoresis and the method of fluorescent antibodies, the PCR method (polymerase chain reaction). These studies allow for several hours to identify the pathogen, and, accordingly, to choose the right treatment.

Meningitis is a dangerous and unpredictable disease requiring mandatory hospitalization and continuous monitoring of medical personnel. At the slightest suspicion of meningitis, emergency medical treatment is necessary in the shortest possible time, and then the disease will recede and not leave after itself complications.

Ural State Medical University, a training film on the theme "Meningococcal meningitis":