Q 1.29. Syndrome of meningeal irritation. Examination methods. Syndrome of increased intracranial pressure.

1. Syndrome of Meningeal Irritation:

   • Definition: Meningeal irritation refers to a set of clinical signs and symptoms that indicate inflammation or irritation of the meninges (the protective membranes surrounding the brain and spinal cord).
   • Clinical Features:
     • Neck Stiffness: Patients may experience stiffness and discomfort when attempting to flex or extend their neck.
     • Kernig Sign: This maneuver involves attempting to extend the knee while the hip is flexed. A positive Kernig sign occurs when pain and resistance prevent full extension due to meningeal inflammation.
     • Brudzinski Sign: When the patient’s neck is flexed, involuntary flexion of the hips and knees occurs. This sign is indicative of meningeal irritation.
   • Diagnostic Approach:
     • Cerebrospinal Fluid (CSF) Analysis: Lumbar puncture is essential for diagnosing meningitis. Examination of CSF obtained through lumbar puncture helps differentiate between bacterial and aseptic (viral) meningitis.
   • Management:
     • Prompt Treatment: Delayed initiation of antibiotics can worsen outcomes. Start treatment promptly, especially in cases where transfer, imaging, or lumbar puncture may delay a definitive diagnosis.
     • Empiric Antibiotics: Tailor empiric antibiotic therapy based on patient age, risk factors, and likely pathogens.
     • Vaccination: Vaccination against common bacterial meningitis pathogens is recommended.
     • Chemoprophylaxis: Prevent additional infections by providing chemoprophylaxis to close contacts.
   • Clinical Challenge: Meningitis etiologies vary widely in severity, making timely diagnosis and treatment crucial.

2. Syndrome of Increased Intracranial Pressure (ICP):

   • Clinical Signs:
     • Papilledema: Swelling of the optic disc due to increased ICP.
     • Focal Neurologic Deficits: These may include weakness, sensory changes, or cranial nerve abnormalities.
     • Seizures: Especially concerning if patients have HIV infection or immunocompromised status.
     • Deterioration in Consciousness: Altered mental status due to elevated ICP.
   • Diagnostic Approach:
     • Neuroimaging: Contrast-enhanced CT or MRI is performed before lumbar puncture if signs of increased ICP or mass effect are present.
   • Management:
     • Address the underlying cause (e.g., tumor, hemorrhage, infection).
     • Intracranial Pressure Monitoring: In severe cases, monitoring ICP is crucial.
     • Medical Measures: Osmotic agents (e.g., mannitol), diuretics, and other supportive therapies.
   • Clinical Importance: Recognizing and managing increased ICP promptly can prevent serious complications.

References:

1 aafp.org

2 msdmanuals.com 

3 vinmec.com

4j ournals.sagepub.com