Purulent Meningitis: Classification

PURULENT MENINGITIS This is an acute infection of the lining of the brain caused by bacteria CLASSIFICATION 1. Pachymeningitis 2. Leptomeningitis REASON Bacteria Virus Rickettsia Mold Worm Protozoa PREDISPOSITION FACTORS 1. Sepsis 2. Immunological disorders 3. Ventricular shunting 4. Lumbar function & spinal anesthesia 5. Parameningeal infection CAUSES OF MENINGITIS BY AGE GROUP 1. Neonates: - Esherikhia coli - Beta hemolytic streptococcus - Listeria monocytogenes 2. Children ≤ 4 years: - Hemophilus influenza - Meningococcus - Pneumococci 3. Children ≥ 4 years: - Meningococcus - Pneumococci PATHOLOGY Superficial vascular dams & pia mater in subarachnoid MS PATHOGENESIS Germs reach the lining of the brain & subarachnoidea through: 1. Open wound on the head 2. Direct spread – otitis media & paranasal sinuses 3. Vascular sepsis 4. Extradural abscess, subdural, and brain abscess 5. Spread of pneumonia 6. Spread of skin infections 7. Lamina cribrosa ethmoidal osis rhinorrhea CLINICAL FEATURES • Shivering heat • Continuous headache • Nauseous vomit • Loss of appetite • General weakness • Back+joint pain • ≥ 12 – 24 hours: neck stiffness, kerning signs, td. Brudzinsky • Afraid & sensitive to light stimuli • Seizures in children and adults are rare • Sometimes paralysis of N.VI, N.VII, N.VIII • Sufferers are restless, mentally confused, hallucinating, hyperactive • Severe coma CAPITAL TRAUMA Injuries to the skin, tendons and muscles → bleeding, swelling, pain Sub gallial bleeding → severe swelling, large head shape. Skull fracture → suture stretching occurs Cerebral Commusio (brain concussion) • Fainting <10 mt • Vertigo, vomiting, pale • Retrograde amnesia • Not accompanied by brain tissue damage Traumatic Cerebral Edema • Fainting >1o mt • No neurological damage • Headache, vertigo, vomiting • Cerebral Contusion • Recognition in the brain jar • There is a neurological disorder • Decreased consciousness • After 6 hours, neurological deficits appeared • Cerebral edema-increased intracranial tech Diencephalon→pupils are small, good light reflex Mensencephalon & upper pons→decreased consciousness, lost light reflexes, irregular eye movements, hyperventilation breathing Lower pons → vestibular disorders, irregular breathing Disturbed medulla oblongata → shortness of breath Epidural hematoma Occurs between the skull & dura mater → brief fainting, severe headache, decreased consciousness, pupil on the same side is dilated • Subdural Hematoma (dura mater & arachnoid) Symptoms are almost the same as an epidural. blood can clot, symptoms like a tumor: progressive pain, decreased visual acuity, pupillary edema, neurological deficit EPILEPSY • Etiology • Idiopathic → 50% of childhood epilepsy2 • Symptomatic – Age 0-6 months • Intrauterine abnormalities • Childbirth abnormalities • Congenital abnormalities • Metabolic disorders • Brain infection – Age 6 months-3 years • So • Febrile convulsion • Head injury • Heavy metal poisoning – Children 2-teenagers: Viral, bacterial and parasitic infections. – Young age: Injuries, infections, tumors – Elderly: brain development disorders, trauma, tumors, cerebral degeneration CEREBRAL PALSY Sensomotor disorders (movement and attitude patterns) due to brain damage that has just developed and is not progressive. Cause: Prenatal factors - Familiar predispositio - Maternal influence - Cerebral malformation - Prematurity Perinatal factors - Birth trauma - Kernicterus Post Christmas : birth – 5 years Factors: - Accidents 22.5% - Infection 62.9% - C va {post op } 4.5% - An oxia 7.9% - Malnutrition 2.2% Classification : Movement disorders [tonus] 1. Spasticity - premature - perinatal hypoxia - cerebral trauma - rubella - familiar 2.Athetosis - kernicterus - Tension type - Dystonia - Chorea - Rigidity 3.Ataxia - head injuries - cerebral maldevelopment - cerebral anoxia - encephalitis - cerebral anoxia - birth trauma 4.Atonia 5.Mix Topographical : - monoplegia - hemiplegia - the plegies - diplegia - tri plegia - quadriplegia Infantile reflex • Asymmetrical tonic neck reflex. • Symmetrical tonic neck reflex. • Moro reflex. • Neck righting reflex. • Extensor thrust. • Parachute reaction. • Food placement.