Meningeal symptoms - diagnosis and causes

Reflex reactions, which can be caused in case of irritation of the meninges. Meningism: Symptoms of irritation of the meninges without other symptoms of inflammation or with non-inflammatory changes in the meninges (for example, during a fever not related to the CNS disease).

Causes of meningeal symptoms

Infectious damage to the meninges, subarachnoid hemorrhage, tumors of the meninges and brain, extensive stroke in the area, is localized directly in the ventricles of the central nervous system.

Diagnosis of meningeal symptoms

1. Examination of meningeal symptoms

1) stiff neck muscles - make sure that the patient does not have cervical vertebral instability (for example, after trauma, or during rheumatoid arthritis) and threat of brain wedging: the patient lies on his back on a flat surface; holding the chest with one hand, the second sticks under the back of the head and tries to bend the neck so that the patient touches the sternum with his chin. If the symptom is positive, reflex spasm of the neck muscles does not allow to bend the patient's head to the chest, provokes resistance and pain. The degree of stiffness in the muscles of the occiput is the distance from the chin to the sternum of the patient. In extreme cases, the tension of the neck muscles is so strong that it causes the head to bend backwards and bend the trunk forward (opisthotonus). It is necessary to distinguish other reasons for limited head bend (degenerative changes in the cervical spine, inflammation of the lymph nodes of the neck, severe pharyngitis);

2) the symptom of Brudzinsky:

  • a) upper - approaching the chin to the sternum when examining the rigidity of the occiput muscles causes reflex flexion of the legs in the hip and knee joints;

  • b) lower - the same reaction is the bending of the legs, caused by pressing the lonnoe articulation;

  • 3) Kernig symptom - the patient lies on his back on a flat surface; Should bend the patient's leg in the hip joint by 90 °, try to unbend it in the knee joint. If the symptom is positive, reflex muscle contraction does not allow it to do, causing resistance and pain. The Kernig Symptom is two-sided (as opposed to Lacega's tension symptom with lumbar radiculopathy).

  • The sensitivity of meningeal symptoms to the detection of inflammation of the membranes of the brain is very low, especially in infants and elderly people.

    2. Auxiliary studies: lumbar puncture (determination of cerebrospinal fluid pressure, cytological, biochemical and microbiological study[прямая микроскопия, посев и ПЦР ]), neuroimaging surveys (CT, MRI).