A child with a stiff neck

A child with a stiff neck

1. Anatomy

   • Skull
   • Meninges
     • 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
   • Ventricular system
     • Lateral ventricles
       • 3rd ventricle
         • 4th ventricle
     • Foramen of Monro
       • Cerebral Aqueduct
         • Central canal

2. Meningitis

   • Inflammation of the protective membranes covering the brain and spinal cord (meninges)
   • Causes
     • Infectious
       • Viral
         • Bacterial
           • Neisseria Meningitidis
             • Listeria monocytogens
               • H.Influenza
                 • Streptococcus agalactiae
         • Enterovirus
           • Cocxakie virus
             • Echovirus
       • Fungal
         • Cryptococcus newformans
     • Non-infectious
       • injury (head trauma), drugs and cancer
     • Signs and symptoms
       • Fever
         • Headache
           • Neck stiffness
             • Photophobia
       • 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
       • Investigations
         • Lumbar Puncture
           • Insertion of needle in subarachnoid space at levels
             • In Infants: L4-L5 interspace
               • In Adults:  L3-L4 interspace
           • Indications
             • Diagnostic
               • Therapeutic
                 • Anesthesia
                 • Injection of Drug (Antibiotic, Chemotherapy)
               • 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
         • Physical examinations
           • Vital signs
             • Meningeal signs
               • General inspection
                 • Neurological examinations
               • Kernig's sign
                 • Brudzinski's sign
           • Management
             • Newborn
               • Adult
                 • Elderly
                   • Ampicillin + vancomycin + 3rd generation cephalosporin
                 • Vancomycin + 3rd generation cephalosporins
               • Ampicillin + 3rd generation cephalosporin + Aminoglycoside

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