a child with stiff neck

anatomy of the meninges
1. three layers
  1. dura matter
  2. arachnoid matter
  3. pia matter
3. dural folds
cerebrospinal fluid
1. clear, watery liquid that flows around the brain and spinal cord, surrounding and protecting them
2. function
  1. Cushion the brain
  2. Protection
  3. Maintain a stable extracellular environment
  4. Elimination of waste products and filtration
  5. Nutrition
  6. Communication (hormones/releasing factors/ neurotransmitters)
3. 500 mL are produced each day
4. composition
  1. Almost protein free
  2. High chloride concentration
  3. Lower concentrations of albumin, K+,Ca2+ , HCO3- and glucose.
  4. in the choroid plexus
5. CSF analysis
pathophysiology of meningitis
1. invasion of subarachnoid space
  1. hematogenous spread
  2. direct contiguous spread
  3. iatrogenic
  4. cytokine production because of immune system activation
    1. increased permeability
    2. altered cerebral blood flow
    3. increased reactive oxygen species
    4. leukocyte adherence to capillary endothelium
    5. increased intracranial pressure
clinical presentation
1. chills & rigors
2. nuchal rigidity
3. altered mental status
4. focal neurological deficits
5. seizures
6. headache
7. photophobia
8. nausea and vomiting
9. petechial rash
10. in children
  1. bulging fontanelles
  2. jaundice
  3. reduced feeds
  4. irritability
  5. lethargy
  6. toxic appearance
investigations
1. blood culture
2. CSF culture
3. imaging CT/MRI
4. spinal tap / lumbar puncture
  2. indications
    1. diagnostic
    2. therapeutic
    3. anesthetic
  3. contraindications
    1. increased ICP
    2. spinal surgery
    3. skin infection near the site of puncture
    4. coagulopathy
5. physical examination
  1. kernigs sign
  2. Brudzinski's sign
treatment
1. empirical therapy
2. specific therapy
3. coricosteroids therapy
complications of meningitis
1. coordination balance problems
2. speech movement disorders
3. kidney failure
4. vision loss
5. sepsis
6. epilepsy
7. problems with memory and concentration
8. hearing loss

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a child with stiff neck

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	Creado por rama ibrahim hace más de 5 años