What is meningitis
Inflammation of the protective membranes (Meninges) covering the brain and spinal cord.
Causes of meningitis
• Viruses
• Bacteria
• Certain Drugs
(crossing the blood brain barrier
Subpial Encephalopathy
- Ischaemic cell changes
- Neuronal loss
- Seizures in bacterial meningitis (Bad prognosis)
Signs of subpial encephalopathy
Subpial Encephalopathy
• Ischaemic cell changes
- BehavioUral change
- Altered level of consciousness
- Convulsions
- Paralysis
Vasculitis causes
• Phlebetic Process
• Vasculitic signs become evident in the 2nd – 3rd
week post infection
Signs of vasculitis
- Hemiplegia
- Cortical blindness
- Decorticate/ Decerebrate rigidity
- Coma
Signs and symptoms of meningitis
• Rigidity • Sudden high fever • Altered mental status • Increased irritability • Neck stiffness and pain • Neck retraction and back extension • High Fever (cold hands and feet) • Lethargic • Increased sensitivity to light Seizures
Indicators of increased ICP
Headache • Vomiting • Neck Stiffness • Bulging fontanelle • Sutural Separation: “Cracked Pot” Note called Macewen’s sign • Papilloedema – optic disc swelling • Neural tension Kernigs sign Brudinzki
Meningitis diagnosis
Blood tests • CRP (c-reactive protein) • Blood Culture • Blood count Lumbar Puncture • WBC • RBC • Bacteria / virus • Decreased sugar • Frank pus
Casualty management
- BP; HR; O2 Saturation; GCS
- Lumbar puncture to test for infection • Drip to maintain hydration levels
- Identify source of infection
- CXR
- UrineTest
- CT(Suspecttrauma,tumour,abscess)
- Control seizures
Ward Mx
ICU for observation (if necessary) • Ventilate/ oxygenate (if necessary) • Treat source of infection (antibiotics) • Steroids to reduce inflammation of the meninges • Maintain hydration • Control fever • MDT approach • Control seizures • Control ICP • Mannitol (diuretic)
Physiotherapy Rx
Chest Physio • Source of Infection • Compromise recovery • Aspiration • Precautions and Contra-Indications
- Rehabilitation
- Prevent
- Contractures
- Bed Sores
- Strengthen muscles
- Improve function-Highest functional level
- Education
- MDT approach NB
- Adequate follow up
Complications
- Rash
- Cerebral Oedema
- Subdural Effusions
- Convulsions
- Hydrocephalus
- Inappropriate ADH secretion
- Cerebral infarction
- Deafness
- Subdural empyema and brain abscess
- Impaired motor and cognitive function
Prognosis
• Bacterial meningitis if untreated is almost always fatal • Viral meningitis is hardly ever fatal Severity • Age dependent • Underlying cause • Time taken to receive treatment
TB meningitis
Infection
• Reactivation of latent TB
• Complication of existing TB
• Reaches the meninges through the BBB
• The bacteria forms metastatic caseous lesion
• Rich’s Focus
Untreated TBM leads to death in 6 – 8 weeks
Tb meningitis
- Meningeal infection caused by rupture of a caseous focus (Rich’s focus)
- Subcortical region
- Subarachnoid space
- Triggers inflammatory response • Base of the brain = tubercles
- Gravity dependant
- Thick exudate covers the cranial nerves, blood vessels and choroid plexus
Stage 1 TB meningitis
– Signs of meningeal irritation
– No hydrocephalus
– No neurological signs
– Altered consciousness
Stage 2 TBM
– Confusion
– Focal neuro signs
• Squints
• Hemi
Stage 3 TBM
- Stupor
- Delirium
- Neurological signs
- Hemi
- Para
Symptom of TBM
Papilloedema • Cranial Nerve VI • Sudden onset of neurological deficits • Hemi • Para • Aphasia • Cerebellar dysfunction • Tremor
Diagnosis of TBM
- Lumbar Puncture
- CSF
- ↑ Cells
- ↑ Protein • ↓ Sugar
- ↓ Chloride
- Careful history
- Skin test (Mantoux test)
Treatment of TBM
- Prevention
- TB medication
- Symptomatic
- Physiotherapy
- Occupational Therapy
