MENINGITIS

MENINGITIS

Pathophysiology

• Direct extension of infections (percontinuatum) caused by infection of the surrounding area (paranasal sinuses, mastoid, brain abscess)
• By the blood stream (hematogenous) that the spread of infection from elsewhere (tonsillitis, endocarditis, pneumonia, tooth infection)
• Direct implantation on open head trauma

Pathogenesis (1)

CNS protection from bacterial infection

Pathogen must be able to pass through the Barrier

Bloodstream Invasion → Pneumococcus Invasion from the nasopharynx into the circulation

 

Pneumococcus in the circulation

  

CLINICAL COMPL OF ABM

  

Clinical picture (1)

Neonatal and infant

- Fever

- lethargi

- Poor feeding

- irritability

- Vomiting and diarrhea

- Apnea

- Seizzure

- Fontanela convex

Children and adolescents

- Fever

- Headache

- Photofobia

- Stiff neck

- Impairment of consciousness

- Seizures

- Focal neurological deficit

- Nausea and vomiting

Clinical picture (2)

Parents

- Fever

- Headache

- Stiff neck

- Impairment of consciousness

- seizures

Examination (1)

1. anamnesis

2. physical examination

3. Examination of imaging (CT scan or MRI)

4. LP

Examination (2)

1. Excitatory signs of meningeal

    - Stiff neck

    - Kernig

    - Budzinski I-IV

2. Other neurological signs

Examination

Cause Of Seizures In Meningitis

1. fever

2. infarction

3. Venous thrombosis with hemorrhage

4. hyponatremia

5. Sub-dural effusion à mass effect

6. antibiotics

Therapy

1. benzodiazepines

    a. Diazepam: 5-10 mg iv or 0.2-0.5 mg iv slowly

    b. Lorazepam: 0.1 mg / kg within 2 minutes

2. Phenitoin

    Adult: 18-20 mg / kg

    Children: 20 mg / kg

3. phenobarbital

    Loading dose of 18-20 mg / kg max 30 mg / kg

4. pentobarbital

    Loading dose of 5 mg / kg maintenance 0.5-5 mg / kg / day