Basicinformation
Cause
1.Purulentmeningitis
Meningealinflammationcausedbyvariouspyogenicbacteriaisalargecategoryofbacterialmeningitis.Itisoneoftheseriousintracranialinfections,oftenaccompaniedbypurulentencephalitisandbrainabscess.Thecommonpathogenicbacteriaare3types,namelyHaemophilusinfluenzaetypeB,Neisseriameningitidis(Diplococcus)andStreptococcuspneumoniae(Streptococcuspneumoniae).Usuallyasmallnumberofhealthypeoplecarrythesegermsinthenoseoronthebodyanddonotharmthehumanbody.Theyarespreadthroughcoughingorsneezing.Peoplearemostlikelytobeinfectedbygermswhentheyhaveacold,becauserhinitismakesitextremelyeasyforbacteriatoentertheskull.
2.Tuberculousmeningitis
Itisanon-purulentinflammationofthemeningescausedbyMycobacteriumtuberculosis.Itaccountsforabout6%ofsystemictuberculosisandisthemostcommoncentralnervoussystemtuberculosis.Itisnotonlythemostserioustypeoftuberculosis,butalsotheleadingcauseofdeathfromtuberculosisinchildren.AftertheinfectionofMycobacteriumtuberculosisisspreadthroughtheblood,itisplantedunderthepiamatertoformtuberculosisnodules.Afterthenodulesareruptured,alargenumberoftuberculosisbacteriaenterthesubarachnoidspace.Inrecentyears,theincidenceandmortalityoftuberculousmeningitishaveincreased.Earlydiagnosisandtreatmentcanimproveefficacyandreducemortality.
3.Viralmeningitis
Itisaninfectionofthecentralnervoussystemcausedbyavarietyofviruses.Virusesthatcancausemeningitisincludearbovirus,enterovirus,Echovirus,poliovirus,CoxsackievirusAandB,Echovirus,myxovirusandparamyxovirus,herpesvirus,arenavirus,etc.Followedbymumpsvirus,herpessimplexvirusandadenovirus.Virusesofteninvadethebrainparenchymaandshowmeningoencephalitis,whichisclassifiedasasepticmeningitis.
4.Cryptococcalmeningitis
Mingingitiscanalsobecausedbyfungi.ThemostcommononeisCryptococcus,whichcanbefoundinpigeonfeces.CryptococcalmeningitisisadeepfungalinfectioncausedbycertainspeciesorvariantsofCryptococcusinvadingthecentralnervoussystem.Healthypeoplearenotsusceptibletofungus-relatedmeningitis,butitisdifferentforthoseinfectedwiththeHIVvirus.CryptococcalmeningitiscanoccurafterinfectionwithCryptococcus.
Clinicalmanifestations
1.Tuberculousmeningitis
Earlymanifestationsarechangesinthechild’smentalstate,suchasirritabilityandcrying;Mentalsluggishness;donotlikegames;mayalsohavelow-gradefever,lossofappetite,vomiting,restlesssleep,weightloss.
Olderchildrencancomplainofheadaches.Iftheconditionissevere,theheadacheispersistentandaggravated,vomitingcanbeaggravatedandcanbecomejet,drowsinessgraduallyappears,andconvulsionsmayoccur.Iftheconditionisfurtheraggravated,coma,frequentconvulsions,looselimbs,andparalysismayoccur.Irregularbreathingmayalsooccur,andsomechildrendie.
2.Purulentmeningitis
Itiscommoninchildrenandtheelderly,causedbyvariouspurulentbacteriaMeningealinflammation.Themainmanifestationsarefever,headache,vomiting,irritabilityandothersymptoms.Nervoussystemexaminationandcerebrospinalfluidexaminationareabnormal.Duetotheweakresistanceofchildrenandtheimperfectdevelopmentoftheblood-brainbarrier,bacteriacaneasilyenterthecerebralnervoussystem.Generally,sepsisiscausedbyinfectioninotherpartsofthebody,andbacteriaenterthebrain.Partlyduetoinfectionafterotitismediaandheadtrauma,bacteriadirectlyenterthemeninges.
Inchildhood,theonsetisrapid,withhighfeverreachingabove39℃.Childrenoftencomplainofsevereheadache,poorspirits,fatigue,lossofappetite,andfrequentvomiting.Attheonsetoftheillness,thechildisconsciousanddrowsiness,confusion,disorganizedspeech,inabilitytodistinguishthedirectioncorrectly,convulsions,andcomamayoccurintheprogressofthedisease.Inseverecases,convulsionsandcomaappearwithin24hoursaftertheonsetofillness.Ifitisnottreatedintime,theconditionprogresses,theneckisstiff,theheadistiltedback,thebackisstiff,andthewholebodybendsbacklikea"bow",whichismedicallycalledreflex.Irregularbreathingmayalsooccur,andevenrespiratoryfailuremayoccur,andsomechildrenhavebleedingspotsontheskin.
Becausethelesionscancausemeningealadhesionsandbrainparenchymaldamage,cranialnervepalsy,blindness,hearingimpairment,limbparalysis,epilepsy,andmentalretardationcanoccur.
Examination
1.Laboratoryexamination
(1)BloodpicturePeripheralbloodpicturewhitebloodcellsinacutephaseThecountissignificantlyincreased,andimmaturecellsmayappearmainlyduetoneutrophils.
(2)CerebrospinalfluidIncreasedpressure,turbidandpus-likeappearance,whitebloodcellcountbetween1000～10000/mm,higherinafewcases,mainlyneutrophils,butItaccountsformorethan90%ofthetotalnumberofwhitebloodcells.Sometimestheaccumulationofpuscellsislumpy.Atthistime,thesmearandthecultureofpathogenicbacteriaaremostlypositive.Occasionally,thefirstlumbarpuncturewasnormal,anditbecamepurulentafterafewhours.Theproteinincreases,upto1.0g/Lormore,thesugarcontentdecreases,usuallylessthan2.2mmol/L,thechloridecontentalsodecreases,andtheimmunoglobulinIgMandIgGincreasesignificantly.
(3)BacterialantigendeterminationCommonlyusedmethodsincludepolymerasechainreaction,convectionimmunoelectrophoresis,latexagglutinationtest,enzyme-linkedimmunosorbenttest,radioimmunoassay,etc.
(4)Otheroptionaltestsinclude:hematuria,bloodelectrolytes,bloodsugar,liverandkidneyfunction.
2.Otherauxiliaryexaminations
(1)X-rayradiographyChestX-rayisparticularlyimportantforpatientswithpurulentmeningitis,Canfindpneumonialesionsorabscesses.Craniocerebralandsinusplainfilmcanfindskullosteomyelitis,sinusitis,mastoiditis,buttheCTexaminationoftheabovelesionsisclearer.
(2)CTandMRIexaminationsEarlyCTorcranialMRIexaminationsofthelesioncanbenormal.Whenthereareneurologicalcomplications,abnormalmanifestationssuchasenlargementoftheventricles,narrowingofthesulcus,swellingofthebrain,andshiftingofthebraincanbeseen.Andcanfindependymitis,subduraleffusionandlocalizedbrainabscess.EnhancedMRIscanismoresensitivetothediagnosisofmeningitisthanenhancedCTscan.MRIscanscanshowmeningealoozingandcorticalreactions.Withappropriatetechnicalconditions,itcanshowvenousocclusionandinfarctionofthecorrespondingpart.
Diagnosis
Inadditiontoclinicalmanifestationsandexaminations.Lumbarpunctureshouldbedonetodiagnosemeningitis.
Complications
Ifthetreatmentisimproper,thelesioncanbechangedfromacutetochronic,andthefollowingsequelaemayoccur:
1.Hydrocephalus
b>Duetomeningealadhesionsandcerebrospinalfluidcirculationdisorders;
2.Paralysisofcranialnervedamage
suchasdeafness,Visualimpairment,strabismus,facialnerveparalysis,etc.;
3.Cerebralvasculitiscauseslumenobstruction
Causescerebralischemiaandinfarctionincorrespondingparts.
Treatment
Bacterialmeningitisisalife-threateningdiseaseandshouldbetreatedimmediately.Gototheemergencydepartmentimmediatelywhensymptomsappear.
Thetreatmentofbacterialmeningitisismainlytofindbacteriabasedoncerebrospinalfluidsmearsandculture,selecteffectiveantibioticsbasedondrugsensitivitytests,andtreatthemintimetoreducetheoccurrenceofsequelae.Itisnecessarytotreathighfeversymptomatically,controlconvulsions,reduceintracranialpressure,reducecerebraledema,andusehormonestoreduceintracranialinflammationandadhesion.
Antibioticshavenoeffectonviralmeningitis,andantiviraldrugsshouldbeadded.
Prevention
1.Earlydetection,isolationandtreatmentonsite.
2.Doagoodjobofhygienepromotionduringtheepidemic,trytoavoidlargegatheringsandgroupactivities,donotbringchildrentopublicplaces,andwearmaskswhengoingout.
3.Duringepidemicsofmeningococcaldisease,anyonewhohasfeverwithheadache;malaise;acutepharyngitis;skinandoralmucosalhemorrhagecanbeusedforsymptomaticpreventivetreatmentwithdrugs,whichcanbeeffectiveToreducetheincidencerateandpreventtheepidemic.
4.Vaccineinjection.
Whydoesmeningitiscauseheadaches?
Mingingitiscanbedividedintomanytypes.Accordingtothecause,itcanbedividedintocommonbacterial,tuberculosis,viral,fungal(mold),meningealcancer,etc.,andacutemeningitisaccordingtothespeedofonsetInflammation,suchascommonbacterialandviralinfections,ismostlyacute;chronicmeningitisismorecommonintuberculousorfungalinfections.Themainclinicalmanifestationsofacutepatientsarefever,headache,andneckandoccipitalstiffness.Forchronicpatients,headacheisthemaincause.Meningitisreferstosurroundingthebrainandspinalcord...
ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,comesfrom:EncyclopediaFamousMedicalNetwork
Suddenlyhaveahighfever,headache,Whatdiseaseshouldbeconsideredforvomiting?
Headache,nauseaandvomitingarealsocommonsymptomsofinfection.Whenhighfever,chills,headache,andvomitingareaccompaniedbyneckstiffness,andheadacheworsenswhentheheadislowered,thepossibilityofacutemeningitisshouldbehighlysuspected,andthehospitalshouldbeconsultedintime.Acutemeningitisisfierceandthemortalityrateishigh.Epidemicmeningitiscausedbymeningococcusiscommon,referredtoasmeningococcalmeningitis,andmeningitiscausedbypneumococcusisalsomorecommon.Thesepatientsoftenhavecold-likemanifestationsinthedaysbeforetheonset...
ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,from:EncyclopediaFamousMedicalNetwork