a child with stiff neck

a child with stiff neck

1. anatomy of the meninges

   • three layers
     • dura matter
     • arachnoid matter
     • pia matter
   • dural folds

2. cerebrospinal fluid

   • clear, watery liquid that flows around the brain and spinal cord, surrounding and protecting them
   • function
     • Cushion the brain
     • Protection
     • Maintain a stable extracellular environment
     • Elimination of waste products and filtration
     • Nutrition
     • Communication (hormones/releasing factors/ neurotransmitters)
   • 500 mL are produced each day
   • composition
     • Almost protein free
     • High chloride concentration
     • Lower concentrations of albumin, K+,Ca2+ , HCO3- and glucose.
     • in the choroid plexus
   • CSF analysis

3. pathophysiology of meningitis

   • invasion of subarachnoid space
     • hematogenous spread
     • direct contiguous spread
     • iatrogenic
     • cytokine production because of immune system activation
       • increased permeability
       • altered cerebral blood flow
       • increased reactive oxygen species
       • leukocyte adherence to capillary endothelium
       • increased intracranial pressure

4. clinical presentation

   • chills & rigors
   • nuchal rigidity
   • altered mental status
   • focal neurological deficits
   • seizures
   • headache
   • photophobia
   • nausea and vomiting
   • petechial rash
   • in children
     • bulging fontanelles
     • jaundice
     • reduced feeds
     • irritability
     • lethargy
     • toxic appearance

5. investigations

   • blood culture
   • CSF culture
   • imaging CT/MRI
   • spinal tap / lumbar puncture
     • indications
       • diagnostic
       • therapeutic
       • anesthetic
     • contraindications
       • increased ICP
       • spinal surgery
       • skin infection near the site of puncture
       • coagulopathy
   • physical examination
     • kernigs sign
     • Brudzinski's sign

6. treatment

   • empirical therapy
   • specific therapy
   • coricosteroids therapy

7. complications of meningitis

   • coordination balance problems
   • speech movement disorders
   • kidney failure
   • vision loss
   • sepsis
   • epilepsy
   • problems with memory and concentration
   • hearing loss

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