Meningitis is an inflammation of the membranes of the spinal cord and brain. It belongs to those diseases whose terrible consequences are known not only to people with medical education. The quality of life after inflammation has largely depended on the timeliness and correctness of treatment. In order not to omit the very moment that gives a chance for a cure without serious consequences, one must be able to recognize the disease at an early stage. But the complexity of the course of meningitis is that the incubation and prodromal periods in some cases can occur instantly, and many patients do not unknowingly perceive the first symptoms of the disease as something serious.
Meningitis is a serious infectious disease that can be caused by bacteria.1, viruses, fungi, parasites, manifest as a complication of other diseases or occur after skull injuries. Depending on the etiology, the pathogenesis of meningitis may be somewhat different, but still there are a number of typical symptoms that make it possible to suspect inflammation of the meninges in adults or children. In medical practice, all typical signs of meningitis can be grouped into 3 syndromes.
General Infectious Syndrome
These are the primary symptoms of the disease, which manifest themselves in most cases. The onset of the disease is always acute. The exception is tuberculous lesions and herpetic diseases, which are "gaining momentum" gradually. The patient's body temperature rises (usually up to 38-40 degrees), chills, apathy, drowsiness, appetite decreases, the skin turns pale, the pulse rate and blood pressure change.
These symptoms are also considered characteristic of all types of meningitis. An invariable signal of the disease is a strong, bursting headache, which is distributed throughout the skull. It is amplified by the influence of noise or bright light and is not removed by analgesics. In addition, about 2-3 days in patients there is severe nausea and vomiting that are not related to the food consumed. In patients with meningitis, a violation of consciousness and orientation is observed. In some cases, a person may even fall into a coma. Seizures can also be attributed to this group of symptoms.
This group of symptoms is the main guideline for doctors when making a diagnosis in adults or children.
The earliest sign of meningitis is stiffness (intense tension) of the muscles of the neck and neck. Patients almost always intuitively choose the same pose for sleep, in which they feel temporary relief. They lie on their sides, their knees are pressed to their stomach, and their head is thrown back. In this position, the tension of the meninges weakens, hence the temporary relief.
In almost all cases of meningitis in patients, Kernig symptom is observed. This means that a patient with a bent leg in the hip joint will not be able to straighten his knees. A person can’t straighten his legs not because of pain, but as a result of muscle tension in the back of the thigh. Specialists call this condition the tonic shell reflex.
In the presence of the upper symptom of Brudzinsky, a patient with meningitis will not be able to lie on his back with his chin up to his chest, without bending his legs at the knees and hip joints. The average symptom of Brudzinsky is also manifested by involuntary bending of the legs, but this already occurs as a reaction to pressure on the pubic joint (pubis). Brudzinsky’s lower symptom as a sign of meningitis is the involuntary bending of one leg in the knee and hip joint when trying to bend the second leg in the same way. Another way to check for meningitis is to push under the cheekbones of the patient. If at this time the patient reflexively raised his shoulders and bent his forearms (the so-called cross pose), there is reason to talk about the sub-cheekbone symptom of Brudzinsky, which also indicates inflammation in the meninges.
The detection of meningitis in patients is possible according to other symptoms:
- Ankylosing spondylitis (tapping of the zygomatic arch causes contraction of facial muscles);
- Pulatova (tapping the skull causes pain);
- Mendel (pain when pressing on the area of the external auditory meatus);
- Herman (passive bending of the neck causes tension of the big toes).
If the patient experiences severe pain when pressing on the middle of the eyebrow or under the eye (the exit site of the cranial nerves), this also indicates a brain disease.
Meanwhile, absolutely all the signs of the three groups in a sick person appear extremely rarely. But for a preliminary diagnosis, an experienced doctor is enough for 2-3 symptoms.
|Form of meningitis||The most common complaints||How does it begin||Meningeal symptoms, severity||General infection symptoms||Impaired consciousness|
|Serous||Headache, nausea, sometimes vomiting, chills||Acute, often after digestive upset or catarrh of the respiratory tract||Manifest moderate, increased intracranial pressure||Fever (repeated irregularly), lasts 3-7 days||Drowsiness, sometimes hearing impairment, delusional or soporious state|
|Purulent||Headache worsens rapidly, nausea, vomiting, chills||Acute, with a short prodromal period (up to several hours)||Manifest sharply in the first day or even hours||Chills, fever 39-40 degrees, flushing of the skin||Sopor, hearing impairment, hallucinations, delusional state, coma|
|Tuberculous||Severe sweating, fatigue, tolerable headache, nausea, anorexia||Gradually (in rare cases and only in adults - acutely), with signs of asthenia||At first they are almost imperceptible, in the course of the development of the disease, the manifestation increases||Low-grade fever (not more than 37.5), there are signs of intoxication||Consciousness is impaired with a complication of the disease|
Inflammation caused by meningococcus is recognized by a typical headache of the disease, fever, as well as hemorrhagic rash throughout the body. At the initial stage, it looks like ordinary acne, which disappears when pressed on the skin. Within a few hours, a hemorrhagic rash appears - small spots, darker in the center. Usually the first rashes appear on the legs, then spread higher, up to the face. Hemorrhagic rash is a very alarming signal. Bruises spreading over the body are a necrosis of the soft tissues caused by sepsis. If the process is not immediately stopped, death is inevitable.
Signs in babies
The most difficult to diagnose the disease in young children. After all, the baby will not say that he has a headache or nausea. You can suspect something was wrong if the baby became restless, cries out or is very tense from any touch on him. Against the background of bacterial meningitis, infants have increased drowsiness, diarrhea, and the child often spits up. Also, the initial symptoms in crumbs can be manifested by convulsions, arching of the back.
The true symptom of meningitis in a one-year-old baby is a positive reaction to the Lezage symptom. If you hold the child by the armpits (from the back), and at this time he throws his head back and pulls the legs to the tummy, it is time to rush to the neurologist. A healthy child in this position should actively work with the lower limbs. You can also find out about problems with the membranes of the brain thanks to the symptom of Matseven: light tapping (percussion) of the skull gives the sound of a “cracked pot”.
The presence of an infectious disease of the brain in children up to a year can be recognized by the condition of the fontanel. A bad sign if it is tense, pulsating and swelling. Also extremely dangerous symptoms are the constant "brain" cry in the baby and the divergence of cranial sutures. The cause of these symptoms is severe cerebral edema (hydrocephalus).
Manifestation in children and adolescents
The risk of getting meningitis is higher in children under 5 years old. The viral form of the disease in children 3-4 years old usually proceeds with a mild clinical picture, which can not be said about the bacterial form. In children over 6 years old and in adolescents, it is much easier to diagnose meningitis in the early stages, since boys and girls at this age are already able to describe their condition. As a rule, they call the classic symptoms of the disease: severe headache, weakness, vomiting.
With bacterial meningitis, some children may also show signs of tonsillitis (sore throat, coughing) and cervical lymphadenopathy. Seizures are possible at the initial stage of the disease; hemorrhagic rash (a sure sign of meningococcal sepsis) may appear against the background of fever. For children, bacterial meningitis is dangerous serious complications.
Serous meningitis in children and adolescents often appears against a background of viral diseases. This form of the disease is accompanied by fever, general malaise, intoxication. In the case of meningitis caused by the mumps virus, the child increases the occipital, submandibular and cervical lymph nodes. There are also cases that inflammation of the meninges in children occurs due to traumatic brain injuries.
Symptoms in Adults
Among adults, men aged 20-30 are most susceptible to meningitis. The percentage of women among patients with meningitis, as a rule, is lower, only during the period of bearing a child is it easier for expectant mothers to become infected. In adults, the bacterial form of the disease caused by meningococci, pneumococci, and hemophilic bacillus is most often diagnosed. Although in countries where vaccination against meningitis is mandatory, this figure is lower. Sometimes inflammation of the meninges appears as a complication of improper treatment of tuberculosis.
The incubation period of bacterial meningitis in adults is sometimes delayed to 12 days2, then the temperature rises to 38 degrees and signs of nasopharyngitis appear. When the infection enters the bloodstream, the fever reaches 40 degrees and the classic symptoms of meningitis appear: headache, vomiting, neck muscle tension. Bacterial inflammation in adults is as severe as in children: up to 10% of cases result in either severe complications or death3.
Viral meningitis always begins acutely, with severe intoxication and fever. Typically, on the second day, typical meningeal symptoms appear. In most cases, an adult will need several weeks to recover from viral meningitis.
If the inflammatory process affects the cranial nerves, the patient may complain of blurred vision and double vision, he develops ptosis, strabismus, paresis of facial muscles, impaired auditory function, and confusion. In some cases, other non-specific symptoms are possible: tachycardia, bradycardia, convulsions.
What to do at the first sign
At the slightest suspicion of meningitis, an adult or a child should be immediately taken to a hospital or a doctor should be called to his house. With inflammation of the meninges, every minute lost reduces the patient's chance of survival. Treatment of meningitis with alternative methods or independently at home in most cases ends with the death of the patient. Only a doctor, having the results of numerous tests on hand, can diagnose the disease, determine its form and select the appropriate treatment program.
- ↑ ASM (American Society for Microbiology) - Laboratory diagnosis of bacterial meningitis
- ↑ NCBI (National Center for Biotechnology Information, USA) - Methods for the rapid diagnosis of the etiology of meningitis in adults
- ↑ NCBI (US National Center for Biotechnology Information) - Global etiology of bacterial meningitis: a systematic review and meta-analysis
Specialty: infectious disease specialist, gastroenterologist, pulmonologist.
Total length of service: 35 years.
Education: 1975-1982, 1MI, San Gig, highest qualification, infectious diseases doctor.
Science degree: doctor of the highest category, candidate of medical sciences.
- Infectious diseases.
- Parasitic diseases.
- Emergency conditions.