What Is the Connection Between a Stiff Neck and Meningitis?

Acute bacterial meningitis, also known as purulent meningitis, is a inflammation of the meninges caused by purulent bacterial infections. Its clinical features are fever, headache, vomiting, restlessness, convulsions, lethargy, and coma. Babies may have a chimney. Swelling, stiff neck, and purulent cerebrospinal fluid changes, if not treated in time can be life-threatening or cause severe neurological sequelae.

Basic Information

nickname: Purulent meningitis
English name: acute bacterial meningitis
Visiting department: Neurology

Common locations: Meninges
Common causes: Caused by purulent bacterial infections
Common symptoms: Fever, headache, vomiting, irritability, convulsions, drowsiness, coma, babies may have a swollen forehead and a stiff neck

Causes of Acute Bacterial Meningitis

The most common pathogens of acute bacterial meningitis are meningococcus, pneumococcus, and Haemophilus influenzae.

Pathways of bacterial meningitis infection mainly include: hematogenous infection: there are infectious lesions in other parts of the body. When the body's resistance decreases, germs enter the blood to form bacteremia, and bacteria enter the skull through the blood circulation and cause meningitis. Direct spread: direct invasion of infections in adjacent areas (such as sinusitis, otitis media, mastoiditis, brain abscess, craniocerebral trauma, skull osteomyelitis, etc.). Cerebrospinal fluid pathway: Through lumbar puncture or craniocerebral surgery, pathogenic bacteria enter the cerebrospinal fluid and directly cause meningeal infection.

Clinical manifestations of acute bacterial meningitis

1. Usually acute or explosive onset, obvious systemic symptoms in the acute phase, chills, fever and general discomfort, may have symptoms of upper respiratory tract infections such as cough, sputum, headache is a prominent manifestation, and disturbance of consciousness such as lethargy, lethargy , Blurred consciousness, etc. Seizures occur in about 40% of patients, and are more common in the first days after infection.

2. Patients have meningeal signs such as neck stiffness, Kernig sign and Brudzinski sign. Meningeal irritation may not be apparent in elderly or patients with deep coma.

3. In the later stage of the disease, continuous fever, slow response, and even coma may occur. Infants and children may develop symptoms such as enlarged heads and cardia.

4. Some patients may develop symptoms such as hemiplegia and aphasia.

5. Some patients may have more special clinical features, such as meningococcal meningitis, systemic bruising, bruising or purpura may occur.

Acute bacterial meningitis test

Cerebrospinal fluid examination

Cerebrospinal fluid is turbid, and the number of cells is increased. In the early stage, neutrophils are dominant, and in the later stage, lymphocytes and plasma cells are dominant; protein is increased, mostly 1-5g / L; sugar and chloride are reduced; immunoglobulin IgG and IgM increased significantly. Before antibacterial treatment, cerebrospinal fluid smear staining and microscopic examination showed causative bacteria in the cerebrospinal fluid of about half of patients.

Blood test

Peripheral blood leukocytes increased significantly, with neutrophils dominant.

3. Radiological examination

(1) Early CT can be normal, and the course of the disease can be seen as a linear strengthening of the meninges. Subdural fluid can be seen in the crescent-shaped low-density area under the skull. The hydrocephalus shows the expansion of the ventricle, and the low-density area can be seen in the damaged brain Placeholder effect.

(2) In the early stage of magnetic resonance examination, the meninges and cortex showed strip-like signal enhancement and extensive brain edema; mid-cortical and subcortical infarction; hydrocephalus, subdural effusion, and brain atrophy were seen in the later period.

Diagnosis of acute bacterial meningitis

Because acute bacterial meningitis, especially meningococcal meningitis, can cause life death within hours, a correct diagnosis must be made early and emergency treatment must be made.

Acute onset, symptoms such as high fever, headache, vomiting, disturbance of consciousness, convulsions, physical signs of meningeal irritation, cerebrospinal fluid with neutrophils, mainly white blood cells, can be considered. Cerebrospinal fluid bacteria pictures can be confirmed by detecting pathogenic bacteria and positive bacterial culture. During the diagnosis, the disease needs to be distinguished from viral meningitis, tuberculous meningitis, and cryptococcal meningitis.

Acute bacterial meningitis treatment

The onset of this disease is rapid, the mortality is high, and there are many sequelae. Early diagnosis and timely and effective treatment should be emphasized.

Anti-infective treatment

The principle is to use antibiotics early, and usually use broad-spectrum antibiotics before identifying pathogens. If the pathogens are identified, antibiotics that are sensitive to the pathogens should be selected.

(1) Ceftriaxone or cefotaxime, the third-generation cephalosporin of undetermined pathogen, is often used as the first choice for purulent meningitis.

(2) Identify the pathogenic bacteria pneumococcal penicillin. For those who are resistant to penicillin, ceftriaxone may be considered. Penicillin is preferred for meningococcal bacteria . Ceftriaxone or cefotaxime can be used for those who are resistant, and chloramphenicol can be used for allergic to penicillin. Haemophilus influenzae ampicillin can be added with chloramphenicol.

Hormone

Hormones can inhibit the release of inflammatory cytokines, stabilize the blood-brain barrier, reduce complications such as meningeal adhesions, and may be considered for patients with severe conditions and no obvious hormone contraindications. General dexamethasone.

3. Symptomatic treatment

Patients with intracranial hypertension were treated with mannitol dehydration to reduce intracranial pressure, fever was symptomatically cooled, and epilepsy could be treated with antiepileptic drugs.

Prognosis of acute bacterial meningitis

The prognosis of acute bacterial meningitis is related to pathogens, body conditions and early effective antibiotic treatment. Early antibiotic treatment and supportive treatment have reduced the mortality of acute bacterial meningitis to less than 10%. However, meningitis is often fatal if treatment is delayed or occurs in the elderly or newborn. Decreased white blood cell count in peripheral blood is a sign of poor prognosis. Survivors may occasionally have sequelae of reduced intelligence, epilepsy, and hydrocephalus.