What Is a Meningomyelocele?

Meningeal irritation is a sign of irritation of the meninges. It is found in various meningitis, subarachnoid hemorrhage, and increased intracranial pressure.

Meningeal irritation

Overview of meningeal irritation

Meningeal irritation is a sign of irritation of the meninges. It is found in various meningitis, subarachnoid hemorrhage, and increased intracranial pressure.

Meningeal irritation is a series of symptoms caused by meningeal disease including neck stiffness, Kernig's sign, Brudzinski's sign

1. Neck rigidity is an important objective sign in meningeal irritation. It is mainly manifested in different degrees of muscle rigidity, especially the extensor head flexion is significantly limited, that is, passive neck flexion encounters resistance, and head flexion is also subject to a certain degree. Restricted, the head rotation movement is lighter, and there is no rigidity in the back of the head. Found in various types of meningitis, subarachnoid hemorrhage, increased intracranial pressure, cervical disease, etc .;

2. Kernig's sign is also known as hip flexion and knee extension test. The patient is supine to flex the knee joint at right angles, and then passively straightens the flexed calf. When the knee joint cannot be straightened, resistance and pain occur and the knee joint is formed. K angle is positive when the angle is less than 135 °. In addition to the positive Kernig sign, there are signs of meningeal irritation, but there is also a stimulus after lumbosacral nerve root disease. The pain is limited to the waist and the affected limb. When the meningeal sign is Kernig sign, it is bilateral and equal in intensity. Not limited to the waist and affected limbs;

3. Brudzinski's patient with supine position supine, bilateral hip and knee flexion occurred when flexing his neck forward; pressing his bilateral cheeks caused bilateral upper arm abduction and elbow flexion; tapping his pubic joint Flexion and adduction of both lower limbs occurred at the same time, both of which were called Brudzinski sign positive.

Meningeal irritation symptoms

Meningeal irritation is a common clinical sign. It is a kind of pathological reflex that causes the corresponding muscle group reflex spasm when the spinal cord is stimulated and affects the spinal nerve root during meningeal disease. For hemorrhagic cerebrovascular disease, blood flows into the subarachnoid space, or inflammation stimulates the spinal nerve roots and the corresponding muscle groups dominated by it, a defensive reactive muscle spasm phenomenon. Mainly manifested as neck stiffness, positive Knig's sign and so on. Meningitis, subarachnoid hemorrhage, and increased intracranial pressure can cause meningeal irritation.

Causes of meningeal irritation

Meningeal irritation infectious meningitis

It is common in inflammation of the pia mater (spinal) membrane caused by bacteria, viruses, Borrelia, fungi and parasites.

1. Bacterial meningitis Suppurative meningitis: such as meningococcus, pneumococcus, streptococcus, staphylococcus, Escherichia coli, Pseudomonas aeruginosa, Proteus, Neisseria gonorrhoeae, Aerobacter, Pneumococcus Non-purulent bacterial meningitis: such as Mycobacterium tuberculosis and Brucella.

2. Viral meningitis such as enterovirus, radon virus, arbovirus, and mumps virus.

3, other biological infectious meningitis such as Cryptococcus, Leptospira, Rickettsia, Toxoplasmosis, amoeba, cysticercosis, schistosomiasis and so on.

Meningeal irritation non-infectious cerebral arachnoiditis

1. Traumatic brain trauma can cause hard and soft meningitis and arachnoid inflammation.

2, bloody cerebrospinal fluid subarachnoid hemorrhage or lumbar puncture caused by blood vessels caused by cerebral ketones.

3. Cancerous meningitis such as meningeal metastasis of cancer, meningeal infiltration of leukemia, lymphoma.

4. Reactive meningitis is secondary to systemic infection, poisoning, and infections such as ear and nose.

5. Intracerebroventricular or intrathecal injection of drugs or contrast agents, whether water-soluble or water-insoluble, as chemical factors, animal tests have confirmed that they cause meningitis.

Meningeal irritation test method

1 Meningeal irritation method 1

The patient with stiff neck lies on his back, the examiner gently supports the patient's head with his hand, and passively causes him to bend forward. The normal mandible can contact the chest. If the lower jaw cannot approach the front chest and there is resistance, it indicates that the neck is rigid.

2 Meningeal irritation method 2

Kneiger's sign (Knee flexion and straight leg test) The patient lies on his back with the knees bent at a right angle, and then passively straightens the calf. There is no restriction under normal conditions. If it cannot be straightened, when resistance and pain occur, the angle formed by the knee To judge, if it is less than 135 degrees, it is positive.

3 Meningeal irritation method 3

Lassier's sign (straight leg test) The patient lies on his back with his legs straight. The examiner lifted the patient's lower extremity (knee straight), made an angle with the hip joint, less than 70 °, and had positive pain and resistance.

4 Meningeal irritation method 4

Brusinski sign

The patient with the neck sign is lying on his back. The examiner lifts the patient's head with his right hand and flexes his neck forward. If the patient's knee and hip joints flex at the same time, it is positive.

Meningeal irritation diagnosis

Meningeal irritation history

There are many reasons for meningeal irritation. For patients with meningeal irritation, a detailed and reliable medical history and meticulous physical examination are very important. Most patients can make a clear diagnosis of the cause through the medical history and physical examination of the clinician, and pay attention to the disease when asking the medical history. Hurry. Time of onset, accompanied by symptoms such as headache. Vomit. Fever and night sweats. Lack of appetite. anxious. Weight loss, etc.

Presence of hypertension, diabetes, heart disease, cerebrovascular malformation, infection, headache, epilepsy, trauma, pneumonia, sore throat, diarrhea, sexually transmitted diseases, tuberculosis, brucella, herpes, mumps, cryptococcus, hook Treponema pallidum, Rickettsia, toxoplasmosis, amoeba, cysticercosis, schistosomiasis, metastasis of cancer, leukemia, lymphoma, and systemic infections. Poisoning, infections such as ear and nose, and intraventricular or intrathecal injection of drugs or contrast agents

Meningeal physical examination

For patients with meningeal irritation, examination should be focused on, including: body temperature. pulse. blood pressure. Respiration; with or without trauma; with or without skin. Bleeding. And sweating; irrespective of papillary oedema in the fundus. Bleeding and exudation; coma. twitch. Respiratory abnormalities. Pupil changes, etc .; Pay attention to respiratory or digestive symptoms such as vomiting during infancy. diarrhea. cough. fever. rash. Lethargy. Irritability. Feeling allergic. Dazed eyes, etc., the forefinger has not been closed, the bone suture can be cracked, so that the symptoms of high intracranial pressure and meningeal irritation appear later or inconspicuously;

Meningeal irritation laboratory test

1. The total number of white blood cells and neutrophils increased significantly during purulent meningitis.

2. Cerebrospinal fluid should be measured for pressure and sent routinely. Biochemical. cytology. Immunoglobulin and enzymological tests, if necessary, tuberculosis-specific antibodies and / or blood and cerebrospinal fluid bacteria culture, cysticercosis tests, etc., for meningitis. Diagnostic significance of subarachnoid hemorrhage

Meningeal irritation test

1.EEG has diagnostic significance for encephalitis

2. Craniocerebral CT examination is performed when there are signs of the nervous system or complications. Subarachnoid hemorrhage, enlarged ventricles, brain swelling, subdural effusion, brain abscess, and epidural abscess can be seen. Abnormal low-density around the ventricle during ependriitis.

3. Craniocerebral MRI can show changes in early meningitis cerebrospinal fluid signals, dilated subarachnoid space, and diffuse cerebral edema. Subcortical infarction and bleeding, or subdural effusion.

Meningeal irritation prevention

Pay attention to nutrition and strengthen exercise to improve physical fitness; work and rest moderately maintain emotional optimism; actively treat primary tuberculosis and completely eliminate tuberculosis lesions to prevent secondary infections; vaccination with BCG vaccine on time can not only prevent the occurrence of tuberculosis, etc., but also inoculate BCG vaccine in the newborn period. So that the incidence of tuberculous meningitis is significantly reduced.