Understanding Meningitis: Causes, Symptoms & Diagnosis
Explore the details of meningitis, including its bacterial and viral causes, pathogenesis, clinical features, and diagnostic criteria. Learn about the inflammatory process, potential complications, and common signs to watch for in patients.
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Meningitis Dr. R C Hiremath
Meningitis Definition: Bacterial invasion and subsequent inflammation of pia and exudation in CSF of subarachnoid space. arachnoid with Bacterial meningitis is also known as septic meningitis or pyogenic meningitis.
Causes Bacterial: Gm-ve bacilli Group Strreptococcus Haemophilus influenza Neisseria meningitidis Strptococcus pmeumoniae Listeria monocytogenes Mycobactrium TB
Viral causes: Enterovirus Mumps Influenza Herpes HIV Parasites: Cystericus Amoeba Fungi: Candidiasis, Histoplasma
Pathogenesis Air borne route. It colonize in the nasopharyngeal mucosa. To attach to mucosal epithelial cells theses bacteria secrete IgA protease enzyme that breakdown the protective allowing bacterial attachment to epithelium. Then they invade the adjacent intravascular space and gain access to blood stream and finally enter the CSF through the choroid plexus of lateral ventricles. It can occur by Haematogenous spread, middle ear infection, par nasal sinuses and skull fractures. mucosal barrier
Pathology Formation of purulent exudate Brain is congested, oedematous and ischemic Inflammatory exudate can cause arteritis or venous thrombophlebitis with resultant cerebral infarction Hydrocephalous can result from obstruction of CSF
Clinical features: Headache, drowsiness, fever and neck stiffness are the usual presenting features. Photophobia, vomiting, lethargy, or an altered level of consciousness. Stupor and coma. Convulsions. O/E: Petechial rashes, painful swollen joints, cranial nerve lesions. Kernig s sign: Restriction of extension of knee when hip flexed to 90 Brudzinski s sign: Flexion at the hip and knee resulting from flexion of neck.
Diagnosis: CSF Pressure increased, CSF turbid and purulent. Proteins - >500mg/dl Glucose - <40mg/dl Cell count: Polymorphonuclear leucocytes Blood culture : Positive
Acute viral meningitis Inflammation of meninges due to viral infection and in majority of cases is a benign, self limiting illness. Aseptic meningitis: CSF sterile and normal sugar content. is bacteriologically
Clinical features: All age group are susceptible but is more common in below 30yrs of age. Prodromal phase with fever, headache, myalgia and malaise. Skin rashes and GIT observed. Measles and chickenpox usually present with their classical skin lesions before imvading the CNS. symptoms are also
Diagnosis: CSF: clear fluid with mildly raised pressure Proteins: Moderately increased Sugar: Normal Cells: Increased lymphocytic infiltration
Tubercular Meningitis Involvement of meninges by mycobacterium tuberculosis. CNS is affected secondarily. Pathology: Involves basal meninges, vascular system and parenchymal tissue of brain parenchyma. Meningoencephalitis Vasculopathy Tuberculoma
Clinical features: Apathy, listlessness, irritability, lack of appetite, nausea vomiting, abdominal pain and fever. Neck rigidity Kernigs sign Epileptic seizures.
Diagnosis: CSF Pressure: >300mm of H2O, turbid form, fibrin coagulum Cob Web Proteins: Increased >500mg/dl Glucose: Decreased Cells: Lymphocyte predominant Demonstration of bacilli in smear or culture.
Homoeopathic Therapeutics Belladonna: stage, Convulsions during fever. Congestive headache < slight noise, jar, motion, light, least exertion. > pressure, tight bandaging, wrapping up, during menses. Cicuta virosa: Brain disease from suppressed euptions, Injurious concussions of the brain and spine especially spasms. Acute meningitis, congestive chronic effects from
Helleborous scarlatinal rapidly. Autonomic motion of one arm and leg. Boring head into pillow, rolling from side to side, beating head with hands. Meningitis Acute, cerebrospinal, exudation. Paralysis more or less complete. Convulsions with extreme coldness of body, except head or occiput which may be hot. niger: or Hydrocephalous tubercular post which develops tubercular with
Veratrum viride: Congestion especially to base of brain. Nervous or sick headache with violent nausea and vomiting. Congestive apoplexy, hot head blood shot eyes, thick speech, slow full pulse, hard as iron. Tongue white or yellow with red streak down the middle. Convusions dim vision, basilar meningitis, head retracted, child on verge of spasms.
Nat -Sulph: Spinal meningitis: violent, crushing gnawing pains at base of brain, head drawn back, spasms with mental irritability and delirium, violent congestion of blood to head, delirium, opisthotonos. Chronic brain effects of blows, falls.
