A child with a stiff neck

A child with a stiff neck

1. Anatomy

   • Skull
   • CSF
     • Secretion
       • From the choroid plexus, which are found on the lateral ventricles, roof of the 3rd ventricle, and the 4th ventricle
     • Absorption
       • Absorbed from the superior sagittal sinus through the arachnoid villi
     • Circulation
       • Through the ventricular system
   • Meninges
   • Ventricular system
     • Lateral ventricles
       • 3rd ventricle
         • 4th ventricle
     • Foramen of Monro
       • Cerebral Aqueduct
         • Central canal

2. Meningitis

   • Pathology
     • 1. penetrate the blood-brain barrier
       • 2. endotoxin and inflammatory mediators
         • 3. leakage of protein and fluid out of the cerebral vasculature
           • 4. causing cerebral edema , increase intracranial pressure
             • 5. lead to a reduction in cerebral perfusion
               • 6. Brain death
   • Management
     • Newborn
       • Adult
         • Elderly
           • Ampicillin + vancomycin + 3rd generation cephalosporin
         • Vancomycin + 3rd generation cephalosporins
       • Ampicillin + 3rd generation cephalosporin + Aminoglycoside
   • Physical examinations
     • Neurological examinations
     • General inspection
     • Meningeal signs
       • Kernig's sign
         • Brudzinski's sign
     • Vital signs
   • Investigations
     • Lumbar Puncture
       • In Infants: L4-L5 interspace
         • In Adults:  L3-L4 interspace
       • Indications
         • Anesthesia
         • Therapeutic
           • Injection of Drug (Antibiotic, Chemotherapy)
         • Diagnostic
           • Sample CSF (Infections, Cancers, Subarachnoid Hemorrhage, Neurologic Disorders)
             • Measure pressure
       • Contra-indications
         • Increased intracranial pressure
           • Infections at the level of insertion
             • Uncorrected Coagulopathy
       • Complications
         • Severe headache
           • Hemorrhage
             • Back pain
   • Signs and symptoms
     • Fever
       • Headache
         • Neck stiffness
           • Photophobia
   • Causes
     • Infectious
       • Bacterial
         • Neisseria Meningitidis
           • Listeria monocytogens
             • H.Influenza
               • Streptococcus agalactiae
       • Viral
         • Enterovirus
           • Cocxakie virus
             • Echovirus
       • Fungal
         • Cryptococcus newformans
     • Non-infectious
       • injury (head trauma), drugs and cancer

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