Meningitis

Done By: Dalal F. AlanaziMedical student at KFU

Summary for case!

9 month-old boy his head has grown so big. He isn’t able to keep his balance when sitting.

Before two month he was admitted to hospital because of high fever and drowsiness. His

eyeballs are turned downwards slightly.

Objectives

• Identify Meninges & Meningitis.• Causes of Meningitis.• Topical signs for Meningitis & Septicemia.• Pathophysiology of bacterial meningitis.• What’s “TB meningitis” and its symptoms?• Third cranial (Oculomotor) nerve palsy and the dorsal

midbrain syndrome (Parinaud syndrome).• The relationship between the child’s present

in this case and Febrile disease.

• Meningitis & Septicemia.

Meninges & Meningitis

• The meninges are three layers of protective tissue that surround the brain and spinal cord.

• Meningitis: is a serious inflammation of the meninges.

Anything ends with “itis” it means inflammation such as Appendicitis and Tonsillitis *

• Septicemia is an infection of the blood often caused by bacteria. It knows as blood poisoning.

• Unfortunately, in this case the infection its won’t affect the meninges membrane only but also it will affect the “Cerebrospinal Fluid” (CSF).

Meningitis & Septicemiatogether they are deadly combination.

Septicemia vs. Meningitis

Causes of meningitis

Infection

Viral meningitis infective

e.g. Entero viral

Most Common. Less Threatening. Full Recovery.

Bacterial meningitis infective

e.g. Meningococcus

Bacterium

Extremely Dangerous

Caused all Decade

Serious head injury

Topical sign for each !

Meningitis

• Stiff Neck.• Dislike of bright

lights “Photophobia”.

• Worsing Headache.

• Severe muscle pain.

Septicemia

• Diarrhea.• Stomach cramps.• Rash.

Hydrocephalus

• Drawsiness.• Difficulty in

walking.• Double vision.• Slowing of

mental capacity.• Headaches • Neck pain

Tuberculous meningitis

• The symptoms of TB meningitis start slowly, with the first stage of symptoms lasting one to two weeks.

• It affects the meninges, which are membranes that cover the brain and spinal cord.

• It’s caused by the bacteria Mycobacterium tuberculosis.

• Pathology of TB : Infection begins in the lungs (usually pulmonary tuberculosis), and may spread to the meninges by a variety of routes such as by blood stem.

TB Meningitis symptoms

Early Symptoms

• patients can have a low-grade fever, which is a fever higher

Intermediate Symptoms

• As TB meningitis progresses to the intermediate stage, that patients have increased pressure inside their skulls.

• Seizures can develop with TB meningitis in which the infection disrupts the brain's electrical activities.

• With third cranial nerve palsy, patients have problems moving their eyes up and down

The dorsal midbrain syndrome(Parinaud syndrome)

• In the presence of increased CSF (due to reduced flow or absorption), there is 3rd ventricular dilatation.

• That will increased intracranial pressure can cause paresis of cranial nerves III, IV, and VI, and leading to deficiency in dorsal midbrain.

• Baby's eyes appear to be looking down; it characterized by increased intracranial pressure (ICP). The name of this condition is “Setting-sun sign”.

The structure of cranial nerves“Inferior view of the human brain”

Oculomotor nerve palsy

• Third cranial nerve palsy is associated with weakness of several eye muscles; this makes it very difficult to treat.

• An acquired isolated oculomotor nerve palsy in a child is resulting of tumor, by viral illness, bacterial meningitis.

• The usual clinical sign of a third nerve palsy in child is slightly the eyelid is droopy (ptotic) downward location of the involved eye.

Superior Rectus muscle

Inferior Rectus muscle

Medial Rectus muscle

Inferior Oblique

Extraocular Muscle

Cont..

Damage to the extraocular muscles results in downward and lateral deviation of the eye *

Fever is the response of your body fighting an

infection, but if the body is not under control that will

lead to something called …

“Febrile seizure”

Febrile disease• Febrile disease are full-body convulsions caused by high fevers

but without evidence of intracranial infection and common in children be tween 3 months and 5 years of age.

• last <15 minutes, are generalized, and occur only once per 24 hours. Simple febrile

• last >15 minutes, have a focal onset, or occur more than once per 24 hours.

Complex febrile

• differ in some other way from the above, such as a lower temperature than usual, unusual age of the child.

Atypical febrile

Cont..

• During the early stages of bacterial meningitis, seizures result from swelling and pressure in the brain, as well as bacterial toxins in the fluid surrounding the brain.

• Bacterial meningitis may also cause a condition that prevents the body from eliminating fluids properly, which can cause the sodium level in the blood to drop.

summary

• What does meningitis mean?• How its effect brain?• Its signs and symptoms.• Meningitis with Febrile disease.• Name of the abnormality of eye movement and

how its occur?

Reference• http://www.bcmj.org/articles/management-febrile-seizures• http://www.merckmanuals.com/professional/neurologic_disorders/neuro-ophthal

mologic_and_cranial_nerve_disorders/third_cranial_nerve_disorders.html• http://www.meningitis.org/symptoms/babies• http://www.livestrong.com/article/161386-tb-meningitis-symptoms/• http://www.everydayhealth.com/meningitis/preventing-seizures-in-a-meningitis-p

atient.aspx• http://

www.jwatch.org/pa201007280000001/2010/07/28/risk-acute-bacterial-meningitis-children-with