Meningeal syndrome

Meningeal syndrome is a complex of subjective and objective symptoms arising from iritaion of the meninges pathologicaly.

Etiology

The most common evoking factors are:

• neuroinfection;
• subarachnoid hemorrhage;
• tumors − especially meningic carcinomatosis (difuse tumor infiltration of meninges).

Another cause can be for example lesion of the brain tissue etc.

Clinically

Meninges irritation leads to irritation of the nerve roots (passing through meninges) and to contraction of the neck and paravertebral muscles. Typically the patient has tilted head back, lies on their back with flexed lower limbs, states subjective meningeal symptoms and they also can be proved.

Subjektive meningeal symptoms

• headache – typically difused;
• vomiting;
• photo- and phonofobia;
• hyperesthesia;
• fever;
• in advanced stages also qualitative and quantitative disorders of consciousness.

Variably can be nausea and stiff neck.

Objective meningeal symptoms

Upper

• Symptom of neck opposition –impossibility of head anteflex (paient can´t put their chin to their sternum);
• Brudzinski’s sign – patient lies on their back and while passive flexing of the head also flexes lower limb in knee
• spine sign – petient is not able to touch their knee with their forehead
• Amos´s sign – patient is supporting theirself with their hand while sitting, always siting on three limbs
• Lasegue´s sign – reduction of ventral flexion in stretched limbs;
• Kernig´s sign – in a patient lying on his back, we try to extend the lower leg during flexion in the hip joints.

Diagnosis

• Lumbal punction and examination of cerebrospinal fluid;
• CT − in suspicion of a subarachnoidal hemorrhage, inflammatory deposits can be displayed

Differencial diagnosis

• Meningism;
• vertebrogenic disease;
• intracranial expansion processes etc.

References

1. AMBLER, Zdeněk. Základy neurologie. 6. vydání. Praha : Galén, 2006. 351 s. ISBN 80-7262-433-4.

Used literature

• DOSTÁL, Václav, et al. Infektologie. 1. vydání. Praha : Karolinum, 2004. 338 s. ISBN 80-246-0749-2.