Meningeal symptoms in children. Meningeal symptoms (signs) in adults and children

Brain diseases are characterized by the presence of specific symptoms, which are based on meningeal symptoms. These symptoms are the main evidence of the onset of serious changes in the nervous system, and the sooner the disease is recognized and treatment is started, the greater the chance of recovery without serious consequences.

It is no coincidence that meningeal signs bear such a name, since in the vast majority of cases meningitis is the cause of their manifestation. For its various forms, certain symptoms are characteristic, but meningeal ones form the basis.

With meningitis, in addition to inflammatory processes in the brain, there are noticeable changes in the cerebrospinal fluid, and this is one of the features of the course of the disease. There are a number of causes that can cause symptoms similar to meningeal syndromes, but do not affect spinal cord, in particular:

• sunbathing abuse
• excessive saturation of the human body with water (usually occurs after severe dehydration)
• severe course of infectious diseases (salmonellosis, typhoid, influenza)
• alcohol poisoning
• transient disorder cerebral circulation(PNMK)
• allergies
• brain tumors
• radioactive damage to the body

All of the above can cause the development of meningeal syndrome, but in this situation, the treatment is different from the treatment of meningitis.

In addition, there is such a thing as "pseudo-meningeal symptoms", which occur in some diseases that are not associated with lesions. meninges (mental disorders, osteochondrosis). That is why it is important to take into account all the manifestations and correctly diagnose.

Classification

It is time to consider directly the symptoms themselves, which are commonly called meningeal. The meningeal symptom complex includes:

a — posture of a pointing dog, b — Kernig’s symptom, c — Brudzinsky’s symptom

• Kernig's symptom
• brudzinsky syndrome
• headache
• vomit
• ankylosing spondylitis
• Gordon's reflex
• Guillain reflex
• Lesage syndrome
• stiffness of the neck muscles
• the presence of the pose of "pointing dog"
• hyperesthesia

To diagnose a syndrome such as Kernig's symptom, the patient is asked to take a supine position, after which the doctor bends his leg at the hip and knee joint at an angle of 90 °. Flexion is unhindered, but extension has problems. So, due to the tension of the muscles of the back of the thigh, the patient cannot do this on his own.

Brudzinsky syndrome

Brudzinski's meningeal syndrome has several variations, including:

1. Cheek.
2. Lower.
3. Upper.
4. Average.

Cheek - the doctor presses on the patient's cheek, resulting in involuntary bending of the arms in elbow joint, as well as a kind of shrug.

Lower - In the sitting position for the patient, one of the legs is bent, the second is automatically bent along with the first.

Upper - the patient is tilted forward, the legs are automatically bent.

Medium - when pressing on the patient's pubis, the legs are bent.

Often, Kernig and Brudzinsky syndromes occur together with meningitis.

Headache

With the manifestation of meningitis, the headache accompanies the patient constantly and does not stop for a minute. It is one of the most pronounced meningeal symptoms.

Vomit

Gag reflexes can also occur in a patient in the absence of such manifestations as primary signs, such as nausea. Vomiting occurs suddenly against the background of a severe headache and is characterized by a gushing effusion.

In some cases, there is a decrease in the intensity of headache after bouts of gushing vomiting.

Bechterew's syndrome

Bechterew's meningeal syndrome is diagnosed by tapping a finger on the patient's cheekbone. This tapping causes a severe headache on the side of the face where there is inflammation, in addition, this side writhe in a grimace of pain.

Gordon's meningeal syndrome is diagnosed by a neurologist as follows, the doctor wraps his hand around the patient's shin and produces a strong squeeze. As a result, the patient's big toe is unclenched, and the fingers of the hands diverge in different directions.

Guillain reflex

The patient is asked to take a supine position, after which the doctor presses on the front surface of the thigh of one of the legs or squeezes it. As a result of this, the opposite leg involuntarily bends at the knee.

Lesage syndrome

This symptom is typical for infants, and in most cases it is diagnosed in them. The patient rises armpits above the floor, as a result of which the baby's legs are involuntarily drawn in (pulled up to the chest).

Rigidity of the neck muscles

This condition is characterized by hypertonicity of the occipital and cervical muscles and manifests itself in the impossibility or difficulty in performing simple actions, such as turning the head or tilting it.

Often, muscle rigidity is characteristic of young children, but not in quality, but due to the fact that the peripheral nervous system is not fully formed. Therefore, it is extremely important to diagnose the disease in a comprehensive manner and be based on several factors.

Pose "Point Dog"

In some sources, there is such a name as the “cocked trigger” pose. It manifests itself as follows: the patient throws his head back, the body is tense and stretched, the arms are tightly pressed to the chest, the legs are also pulled up to the thoracic region.

Hyperesthesia

Meningeal syndrome hyperesthesia, or increased light and noise sensitivity manifests itself in the form of painful perception by the patient bright light and loud sounds. For this reason, the patient is advised to stay in a darkened room, and, if possible, completely eliminate annoying sounds.

Features of the course of the disease in children

As for children, at an early age it is difficult to diagnose the disease by meningeal symptoms, since most of them do not manifest themselves.

The main symptom characteristic of babies is the Lesage syndrome, as well as a severe headache, against which the child becomes irritable, refuses to eat, and develops apathy.

Rare species

Modern neurology, in addition to the above, there are other meningeal syndromes, however, their manifestations are rare, they include:

1. Levinson's symptom (mouth opening when trying to touch the chest with the chin).
2. Perrault's symptom (dilation of the pupils with any pain effect).
3. Mendel's sign (pressure on eyeballs or at auricles causes pain).

Thus, as soon as the meningeal syndrome manifests itself in a patient, the patient should immediately take measures to contact a specialist and start treatment in a short time, since in addition to mild forms of meningitis, there is a chance of getting sick with its acute forms, which can lead to death.

Meningeal symptoms (meningeal signs) - a concept that includes subjective disorders and objective symptoms that can be determined when examining a patient.

A cardiac meningeal symptom is a headache that is characterized by great intensity (so severe that patients can clutch their heads, moan and even scream in pain), diffuseness (that is, the entire head area hurts) and a feeling that the head is bursting.

Patients suffering from meningeal symptoms constantly feel pressure on the ears, eyes, and back of the head. In addition, head pain may be accompanied by unpleasant sensations in the neck, spine. It also increases in bright light, loud sound, or simply a change in the position of the human body.

If the pain is mostly affected, it may not be as severe. It almost disappears after a person takes a loop duaretic.

Meningeal symptoms are most often characterized by the fact that the headache is accompanied by vomiting and nausea. Moreover, vomiting is not related to food intake. It appears suddenly. In addition to being too sensitive to photo- and sound stimuli, there is also pronounced pain. Painful sensations can occur during palpation, stroking the shoulders, hips and abdomen. In some cases, such symptoms, especially in combination with vomiting and nausea, deceptively mimic the picture acute abdomen.

The most demonstrative of the objective symptoms of meningeal syndrome can be called: the lower and upper symptoms of Brudzinsky, and Kerning's symptoms.

Stiffness can be tested by laying the person on their back and bending their head with their jaws closed. When the syndrome is present, the patient cannot reach the chest with his chin. This is due to the fact that the increased muscle tone in the extensor muscles of the head.

Meningeal symptoms can have varying degrees of severity: weak, in which case the patient is missing only one or two centimeters to touch the chest. Moderate meningeal symptoms, when the patient's chin does not reach the sternum by 3-5 centimeters. With a pronounced symptom, the head does not leave the vertical position at all and is thrown back.

It is necessary to distinguish between muscle rigidity and Neri's radicular symptom. With the latter, it is either impossible to bend your head at all, or it is very difficult due to the fact that strong pain. It is worth noting that rigidity can be combined with the Neri symptom. In addition, difficulty in bending the head may be due to the fact that the lesion has begun. cervical spine.

There are several degrees of severity of meningeal symptoms - from fairly minor to pronounced. When the disease reached late dates, and adequate treatment has not been carried out, patients take a characteristic this disease posture: lying on your side, with your head thrown back and your legs pressed to your stomach. It is also called the position of the pointing dog.

The patient can determine all meningeal symptoms:

Complete syndrome;

When a part is missing characteristic symptoms;

Incomplete syndrome that appears with viral serous meningitis.

There is also such a thing as pseudomeningeal syndrome. It occurs due to causes that impede or exclude movement in the neck, knees, thereby leading to the occurrence of meningeal and stiffness of the neck muscles).

Most often, it is due to the fact that increased muscle tone (parkinsonism), paratonia or orthopedic pathologies, such as spondylarthrosis and spondylosis. There is always a strong pain syndrome.

Inflammations and lesions of the meninges of the brain are more than serious problems that require complex and surgical treatment. Meningeal symptoms allow you to reliably diagnose the disease and start treatment on time. They may appear due to high pressure or as a result of hemorrhage. Some of them can be recognized independently, the identification of others is impossible without the intervention of a specialist.

The main symptoms of meningeal syndrome

There are many symptoms of meningeal syndrome, and most of them are unique. That is, it is quite difficult to confuse the signs of meningeal syndrome with any other diseases. Many specialists have been studying the disease. The most common symptoms they were able to identify are:

1. The main symptom of meningeal syndrome is the rigidity of the cervical and occipital muscles. Symptoms may be severe or moderate. Rigidity of the neck muscles is easy to recognize: the patient cannot touch his chin to his chest. Moreover, contact does not occur even with a weak symptom. And in patients with pronounced stiffness of the muscles of the back of the head, the head can always be slightly thrown back.
2. People suffering from meningeal syndrome very often complain about. In most cases, painful sensations spread throughout the head, but sometimes they can be concentrated in one place: the back of the head, temples, frontal part. In some patients, headache is accompanied by vomiting, which can be difficult to control.
3. Another common meningeal symptom is Kernig's. It consists in the inability to straighten the leg bent at the knee. It is not difficult to determine the symptom: the patient needs to bend the leg at ninety degrees and try to align it. With meningeal syndrome, this is unrealistic: during attempts to unbend knee-joint the leg bends involuntarily, while the patient feels pain.
4. Gillen's symptom is considered a sure sign of meningeal syndrome. Its presence is checked by pressing on the quadriceps femoris muscle. If a person really suffers from meningeal syndrome, he will involuntarily bend his leg at the knee and bring it to his chest. The test is carried out with the patient in the supine position.
5. Neurologists can also determine meningeal syndrome using Bechterew's symptom. With light tapping on the zygomatic arch, the headache intensifies, and the face contorts in a painful grimace.
6. Fanconi's symptom states the disease if the patient cannot rise with straightened fixed knee joints.

Brudzinski's meningeal symptoms

Most specialists begin diagnosing meningeal syndrome by checking the four main symptoms of Brudzinski.

Meningitis is one of the most serious illnesses, which may lead to dangerous complications and even death. Its treatment at home is unacceptable, so it is important to recognize the disease in time. But the danger is that the first signs of meningitis are very similar to those of the flu. Characteristic features irritations of the meninges are meningeal symptoms.

How does meningitis start?

• There are several forms of meningitis disease. Most often, regardless of the form, the first signs of meningitis are general infectious symptoms:
• acute attack weaknesses
• a sharp rise in temperature to 39 degrees
• aches all over the body
• rapid heart rate and irregular breathing

Within a few hours or days, the patient develops symptoms caused by irritation of the meninges:

• which is intensifying. This is a sharp, intense, arching pain that can radiate to the neck, back, less often to the limbs.
• Vomiting that occurs during worsening headache
• Hyperesthesia ( hypersensitivity to touch and light stimuli)
• Stiff neck
• Meningeal posture, symptoms of Kernig, Brudzinsky, zygomatic symptom of Bekhterev, etc.
• Seizures (common in children, rare in adults)

Doctors group these symptoms into meningeal syndrome. The combination of symptoms in meningitis can vary. The main and most permanent signs irritations of the meninges are stiff neck and Kernig's symptom.

Consider the main meningeal symptoms in more detail.

Stiff neck

Due to the reflex increase, which are responsible for the extension of the head, there is stiffness of the occipital muscles. An attempt to bend the head of a sick person lying on his back leads to the fact that, together with the head, it rises and top part torso.

Rigidity of the occipital muscles causes a meningeal posture, which manifests itself:

• head thrown back
• Arched torso
• "Scaphoid" retracted abdomen
• Hands pressed to the chest, legs pulled up to the stomach

Kerning sign

This early symptom damage to the meninges is expressed in the inability of the patient to straighten the leg at the knee joint, which was bent by another person at a right angle in the hip and knee joints.

However, in young children, Kernig's symptom may not appear. And for children under 2 one month old, and in people with Parkinson's disease and myotonia, this meningeal symptom may not be a sign of meningitis, but the result of a physiological or pathological increase in muscle tone.

Other meningeal symptoms include:

• Zygomatic symptom of Bekhterev. When tapping the zygomatic arch, the headache intensifies and an involuntary painful grimace occurs on the corresponding part of the face
• Upper symptom of Brudzinsky. An attempt to bring the head to the chest of the patient, who is in a prone position, causes involuntary bending of the legs at the knees.
• Brudzinsky's zygomatic symptom. The same reaction when tapping the zygomatic arch
• Pubic symptom of Brudzinsky. In response to pressure on the pubic joint, the legs bend at the knees.
• Fanconi sign. The patient is unable to sit up on his own in bed with knees extended and fixed.

Features of meningeal symptoms in children

Meningitis in children early age accompanied by Le Sage's suspension symptom. A sick child, raised under the armpits, pulls his legs to his stomach and holds them in this position, and slightly throws his head back.

In addition, young children are characterized by such a sign of meningitis as Flatau's symptom - dilated pupils with a quick tilt of the head forward.

A characteristic sign of meningitis in infants is a prolonged and persistent bulging of the large fontanel.

However, some meningeal symptoms in young children may not be. The main signs of meningitis in them are convulsions, vomiting with a fountain, regurgitation, constriction of the pupils, paresis of the limbs, changes in the nature of the child's cry.

The diagnosis of meningitis disease is confirmed by the results of the analysis of cerebrospinal fluid.

Elena Kukuevitskaya

Meningeal symptoms should be known to every doctor. This group of symptoms is essential in neurology. Meningeal symptoms occur when the meninges are irritated. Irritation appears, usually as a result of meningitis, but can be triggered, for example, by a hemorrhage inside the brain or the collapse of a tumor. Meningeal signs are of great importance for diagnosing the disease. At the slightest inflammation of the meningeal membranes, the patient should be examined, especially for children. Today, medicine has identified more than 30 symptoms. Meningeal signs are usually named after the author who discovered it. The most significant symptoms will be discussed below.

Kernig's symptomatology is typical not only for children and patients who develop meningitis, but also for people with problems in the knee joints. Meningeal Kernig syndrome allows you to establish an accurate diagnosis in children and adults. The essence of this syndrome is that during flexion and extension of the knee, hip joint(with the help of a doctor) there is no full extension of the leg. This meningeal syndrome is being investigated in 2 stages.

First, the doctor flexes the leg of the patient lying on his stomach, and then relieves pressure and releases the leg, which begins to passively unbend.

In healthy children and adults, this syndrome does not manifest itself, and the leg calmly returns to its original position. Kernig's syndrome allows not only to diagnose the presence of meningitis, but also to determine the extent to which the brain is affected by the infection. In addition, it is possible to determine the prognosis of pathological changes nervous tissue, and in what dynamics the disease develops.

Other options

Shtrumpel's meningeal syndrome is manifested by slowly progressive lower spastic paraplegia. Hand function is preserved. The cranial innervation remains intact. In later stages, urinary incontinence may occur. Sometimes a decline pain. The symptom is checked by pressing on the knee joint. Inflammation of the meninges is diagnosed if, when pressed, the fingers open like a fan, as well as in spontaneous extension thumb legs. When the form of the pathology is complex, then hearing loss, cerebellar ataxia, ichthyosis, etc. can join the symptoms.

Meningeal Guillain syndrome in children and adults is manifested by the following symptoms:

1. Catarrh of the respiratory tract.
2. General weakness, fatigue, malaise.
3. An increase in body temperature to extreme values.
4. Failure in the functioning of the gastrointestinal tract.

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Guillain's meningeal syndrome in children and adults initial stage manifested by general weakness in the muscles of the limbs, which indicates the destruction nerve cells. In the later stages of the development of pathology, loss of sensitivity in the limbs is added. Another meningeal symptom is called Mendel's symptom. Character traits development pathological condition are that in children or an adult patient develops Blunt pain in the area of ​​the appendix. Nausea and vomiting may develop. may appear on the tongue white coating. The next meningeal symptom is Flatau's symptom. A symptom is manifested in the expansion of the pupils of the patient, when he passively or intensively bends his head.

Checking for meningeal symptoms is very important. Brudzinsky's symptomatology checks not only the target organ, but also all systems, because usually the lesion concerns the membranes of the brain and the whole organism as a whole. Brudzinsky's signs are checked as follows:

1. Top sign. The patient should lie on his back and try to reach his chest with his chin. If inflammation of the membranes is present, then his leg will involuntarily bend at the knee and hip joint.
2. Average sign. The patient is lightly pressed on the pubis. Inflammation is present if he pulls his legs to his stomach.
3. The lower sign is tested as Kernig's sign.
4. Cheek sign. The patient is pressed on the area under the cheekbone, and if inflammation of the meninges is present, then the arm of the sick person will bend or the hand will rise.

These signs were introduced into practice by the Polish doctor Josef Brudzinsky. Since the early 20th century, they have been standard in diagnosing meningitis in children and adults.

Another meningeal syndrome that makes it possible to diagnose meningitis is neck stiffness. It can be checked by bending the patient's head from a supine position. The doctor is trying to pull the patient's head to chest, but if there is rigidity (high muscle tone), then this will not work. Elevation of the body may be seen on examination. Neck stiffness is of great importance in the diagnosis of cerebral hemorrhage and meningitis.

The next symptom is the lying dog posture. For severe injuries nervous system disruption of the entire body.

With meningeal syndrome, there is an increase in muscle tone, and the patient acquires the position of a lying dog, or otherwise the position of a cocked trigger. This position indicates that meningitis is extremely difficult. The symptom is unfavorable.

Opisthotonus, trismus of chewing muscles

Opisthotonus is a posture characterized by the head thrown back, deflection in spinal column and kip lower extremities. A person takes this position for inflammation of the meninges, meningitis, tumors, tetanus, or hemorrhagic stroke. Rarely does a person take such a position when he has a hysterical fit. In children, opisthotonus occurs when purulent meningitis or tetanus, indicates brain damage. Another symptom of inflammation of the meninges is lockjaw of the masticatory muscles. It manifests itself as a spasm of these muscles, the inability to freely move the jaw. Potty symptom usually occurs in children who have bacterial meningitis. When the baby sits on the potty, he quickly tries to lean on the floor behind his back.

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He does this in order to avoid muscle tension in the back of the head. Levinson's symptom is very important in the diagnosis of viral, bacterial and tuberculous meningitis. The symptom is very easy to check. The patient, when trying to pull his head to the chest, involuntarily opens his mouth. This feature is not specific and is used in difficult cases. With serous, tuberculosis, viral meningitis Bickel's sign appears. Its development occurs when there is a serious inflammation of the meninges. Sometimes Bickel's symptom manifests itself with cerebral hemorrhage. The sign is expressed by arms constantly bent at the elbows. Also, the patient constantly wants to keep the blanket pulled off him. This state remains the same even if the patient is in a feverish state.

Thanks to all of the above symptoms, life-threatening pathologies can be diagnosed in a timely manner and treatment can be prescribed. After all, treatment started on time gives happy outcome by 80%.