Meningeal irritation sign

Introduction Meningeal irritation is a series of symptoms caused by meningeal lesions, including cervical rigidity, Kernig's sign, and Brudzinski's sign. 1 neck stiffness is an important objective sign of meningeal irritation, which is mainly manifested by varying degrees of muscle rigidity, especially extensor muscles. The head flexion is obviously restricted, that is, the passive flexion neck encounters resistance, and the head side bend is also subject to certain Restricted, the head rotation movement is limited to light, and the head back is not strong. Found in various types of meningitis, subarachnoid hemorrhage, increased intracranial pressure, cervical disease and so on. The 2Kernig sign is also called the flexor and knee extension test. The patient's supine position bends the knee joint into a right angle, and then passively bends the flexed leg. When the knee joint cannot be straightened, resistance and pain occur and the knee joint forms an angle of less than 135°. When the K sign is positive. Kernig sign positive in addition to suggesting that there are signs of meningeal irritation, it is suggested that the posterior root is stimulating, lumbosacral radiculopathy, the pain is limited to the waist and the affected limb, while the meningeal stimulation sign Kernig sign is bilateral, and the same intensity, pain Located on the chest and back and not limited to the waist and affected limbs. 3Brudzinski patients with supine supine, bilateral flexion and knee flexion when flexing the neck; compression of the bilateral cheeks caused by double upper arm abduction and elbow flexion; slamming their pubic symphysis with double lower limb flexion and Adduction, said to be positive for Brudzinski.

Cause

First, infectious meningitis

It is common in the inflammation of the soft brain (spine) caused by bacteria, viruses, spirochetes, fungi and parasites.

1, bacterial meningitis

1 purulent meningitis: such as meningococcus, pneumococci, streptococci, staphylococcus, Escherichia coli, Pseudomonas aeruginosa, Proteus, Neisseria gonorrhoeae, aerobacteria, Klebsiella.

2 non-suppurative bacterial meningitis: such as Mycobacterium tuberculosis, Brucella and so on.

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

3. Other biological infective meningitis such as cryptococcus, leptospira, rickettsia, toxoplasmosis, amoeba, cysticercosis, schistosomiasis, etc.

Second, non-infectious brain arachnoiditis

1, traumatic brain injury can cause inflammatory reaction of hard, soft meningitis and arachnoid.

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

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

4, reactive meningitis secondary to systemic infection, poisoning, as well as infections such as ear and nose.

5, ventricle or intrathecal injection of drugs or contrast agents whether water-soluble or water-insoluble as a chemical factor, animal tests confirmed that meningitis response.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain nerve examination brain function imaging

I. Medical history: There are many causes of meningeal irritation. For patients with meningeal irritation, detailed and reliable medical history and detailed physical examination are very important. Most patients can diagnose the cause of the disease through the clinician's medical history and physical examination. When inquiring about the medical history, attention should be paid to the onset of the disease, the onset time, and symptoms such as headache, vomiting, and fever. Night sweats, lack of appetite, irritability, weight loss, etc.

Have high blood pressure, diabetes, heart disease, cerebrovascular malformation, infection, headache, epilepsy, trauma, pneumonia, sore throat, diarrhea, sexually transmitted diseases, Mycobacterium tuberculosis, Brucella, herpes, mumps, cryptococcus, hook Terminal spirochetes, rickettsia, toxoplasmosis. Amoeba, cysticercosis, schistosomiasis, metastasis of cancer, leukemia. Lymphoma, and systemic infections, poisoning, and infections such as the ear and nose and intraventricular or intrathecal injection of drugs or contrast agents.

Second, physical examination: for patients with meningeal irritation, should be inspected in a focused manner, including:

1 body temperature, pulse, blood pressure, breathing;

2 with or without trauma;

3 skin with or without hair, bleeding, and sweating;

4 fundus edema, hemorrhage and exudation;

5 with or without coma, convulsions, abnormal breathing, pupil changes, etc.;

6 Infants pay attention to respiratory or digestive symptoms such as vomiting, diarrhea, cough, fever, rash, lethargy, irritability, hyperesthesia, eye irritation, etc., the frontal bony has not been closed, the suture can be split, so that the symptoms of high intracranial pressure and Meningeal irritation signs appear late or not obvious;

7 with or without brain nerve palsy.

Third, laboratory inspection

1, blood: the total number of white blood cells and neutrophils increased significantly in purulent meningitis.

2, cerebrospinal fluid: should be measured pressure, sent to routine, biochemical, cytological, immunoglobulin and enzymology examination. Tuberculosis-specific antibodies and/or blood and cerebrospinal fluid bacterial culture, cysticercosis tests, etc., if necessary. It has diagnostic significance for meningitis and subarachnoid hemorrhage.

Fourth, auxiliary inspection

1, EEG: Diagnostic significance for encephalitis.

2, brain CT examination: for possible signs of neurological system or complications. Can see subarachnoid hemorrhage, ventricular enlargement, brain swelling, subdural effusion, brain abscess, epidural abscess, etc., periventricular inflammation, low density abnormalities around the ventricles.

3, craniocerebral MRI: can show early meningitis cerebrospinal fluid signal changes, subarachnoid expansion and diffuse cerebral edema, subcortical infarction and hemorrhage, or subdural effusion.

Differential diagnosis

Differential diagnosis

1. Neck stiffness: Neck stiffness is an important objective sign in meningeal irritation. It is mainly characterized by different degrees of muscle rigidity, especially extensor muscles. The head flexion is obviously restricted, that is, the passive flexion neck encounters resistance, and the head side bends. It is also subject to certain restrictions, the head rotation movement is limited, and the head back is not strong. Found in various types of meningitis, subarachnoid hemorrhage, increased intracranial pressure, cervical disease and so on.

2. Kernig sign: also known as the flexor and knee extension test, the patient supine position bends the knee joint into a right angle, and then passively bends the flexed leg, when the knee joint can not be straightened, there is resistance and pain and the angle of the knee joint is not formed. It is positive for K sign at 135°. Kernig sign positive in addition to suggesting that there are signs of meningeal irritation, it is suggested that the posterior root is stimulating, lumbosacral radiculopathy, the pain is limited to the waist and the affected limb, while the meningeal stimulation sign Kernig sign is bilateral, and the same intensity, pain Located on the chest and back and not limited to the waist and affected limbs.

3.Brudzinski sign: the patient is supine, the bilateral pith and knee flexion occur when the neck is flexed, and the bilateral upper cheeks are pressed to cause double upper arm abduction and elbow flexion, and the pubic symphysis appears double The flexion and adduction of the lower extremities are called positive for Brudzinski.

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