What is meningeal syndrome?

When meningitis is damaged by many different causes, clinical manifestations of meningismus (meningismus) will be seen clinically.

Some characteristics of the structure and function of meninges

Meningeal structure

Meninges (meninx) consists of 3 layers

• Dura mater : Dura mater : A thick fibrous membrane, adhering to the face of the skull and consists of two leaves. In this two-leafed skull cavity, they are only separated in places that form venous sinuses.
• Arachnoidea: A thin film, consisting of loose fibers. The spider web lies close to the inside of the sclera.
• Membrane, also known as pia mater : Sticking to brain organization, there are many blood vessels. Between the spider web and the subarachnoid membrane containing the cerebrospinal fluid.

The function of the meninges is to surround and protect the brain, spinal cord and head of cranial nerves.

When meningitis is damaged by many different causes, clinical manifestations of meningismus (meningismus) will be seen clinically . Special attention should be paid to symptoms of cervical spine pain; In the elderly, children and patients who are lethargic despite the meningeal irritation, the signs often show unknown or even not.

In the case of a typical meningococcal syndrome, patients will find "trigger position".

Method of examination of meningeal syndrome

Functional symptoms

• The patient is tired, his face is listless, his lips are dry, his tongue is dirty, his feeling is increased, his body is thirsty, he has poor urination.
• Body temperature changes, pulse is slow, irregular, skin and mucosa are dry, poor eating.

Observe: in cases of typical meningeal syndrome, the patient will be lying in a "trigger position" (lying on his back, head back and back, hands folded, knees bent to the abdomen, back bent).

Headache is the most common symptom , often pain in the forehead and back of the neck, increased pain when there is noise and light, sometimes severe pain. Sometimes a comatose patient still groans because of a headache, sleeping children suddenly scream.

• Vomiting is easy, sudden vomiting is unrelated to the meal.
• Constipation usually occurs from day 3-4 onwards.

Physical symptoms

Signs hard neck

• The patient is lying on his back.
• The doctor puts his hand into the occipital area of ​​the patient and folds the patient's head forward.
• Normally, the patient's chin is close to the chest, a positive sign when the patient's chin is not close to the chest, because the muscles in the neck are stiff and the neck is limited and causing pain.

Note: Young children with normal muscle strength also increase, so when a stiff examination of the neck, signs of stiffness are less valuable that people lift the baby up, normally the child has two legs and kicks limbs but the young meningitis Just keep your legs forever.

Headache is the most common symptom, often in the forehead and back of the neck.

Kernig sign

• The patient lies on his back, placing his legs perpendicular to his thighs and thighs perpendicular to his body.
• The doctor lifted the patient's leg slowly up the shaft with the thigh.
• In case of meningeal lesions, the muscles of the thighs and lower legs contracting, do not lift the legs up or lift very little, or the patient grunts in pain. It is a positive Kerrnig sign, calculated by the angle created by the legs and thighs.

Brudzinski sign on or occipital Brudzinski

• The patient is lying on his back with his legs straightened.
• The doctor placed his left hand on the patient's chest, his right hand lifting the patient's head.
• Positive signs when the patient is sore and the legs shrink.

Bruzinski signs for the party

• The patient is lying on his back with his legs straightened.
• The doctor folded the patient's one leg on the thigh, folded the thigh into the abdomen.
• Normally, the leg straightening remains the same posture, a positive sign when the leg also shrinks.

Brudzinski mu sign

• The patient is lying on his back with his legs straightened.
• The doctor pressed hard on the shore on the patient's pubic bone.
• A positive sign when the patient has a lower abdomen.

Increased pain feeling

• Scratching the skin or lightening the needle into the skin, the patient complains of pain and reacts very strongly. Pressing on the starting points of V nerves, the occipital neuralgia increases.
• Fear of light so patients like to face the dark side, strong noise makes patients uncomfortable.
• Bone tendon reflex examination: increased steadily in the extremities.
• Sympathetic neurological disorders: the face when red, when it is red, sometimes sweats cold.
• Signs of meningitis (Trousseau sign).
• The patient is lying on his back, his legs are stretched, revealing his chest and abdomen.
• The physician used the needle of the prison to trace the lines on the chest skin, the patient's abdomen on both sides.
• A positive sign when the red line is darker, time lasts longer than a normal person. Attention should be paid to distinguishing from those with allergy organs, having "signs of embossing the skin" close to that of meningeal marks.
• At the end of the irritation symptoms will decrease, the patient goes into a state of struggle, convulsions, neurological disorders and coma.