NIZAR I.

J, MBBS

MENINGITIS INTERN OF INTERNAL

MEDICINE
HMG OLAYA COMPLEX

MENINGITIS
o Meningitis implies serious infection of the meninges
oUsually arising from nasopharynx (hematogenous spread),
obacteremia, or direct inoculation (surgery, contiguous
infection, trauma, foreign body

o The meningitic syndrome:

This is a simple triad: headache, neck stiffness and fever
o+(photophobia, nausea, seizures, GCS 14)
o causative organisms: Str. Pneumonie, N. meningitidis and
listeria



o Special meningeal signs:

okernig’s sign: pain + resistance on passive knee extension with hip fully
flexed
o Brudzinski sign: flexion of the neck with the child supine causes
flexion of the knees and hips
oBabniski sign: dorsiflexion of the great toe (upper motor neuron lesion)
oJolt’s sign: headache worsening with horizontal rotation

 CSF analysis:
o Bacteria: high protein reduced glucose and neutrophilia
o TB: same but lymphocytosis
o Viral: high protein but normal glucose and lymphocytosis
o Neisseria meningitidis: occurs in epidemics,
meningococcemia, DIC and rash, can present by
hypotension due to adrenal crisis (waterhouse frederichson).












Investigations:
o LP + CSF Analysis: for Color & Proteins, glucose.
o CBC [Leukocytosis]
o RFT: ↓ Na+ (SIADH)
o Blood Culture: Especially if CSF –ve. +ve in 50%.
o CT/MRI: meningeal enhancement.












 Complications of meningitis:
₋ ↓LOC / Coma
₋ Convulsions
₋ Obstructive hydrocephalus
₋ Brain Abscess
₋ SIADH
₋ N. Mengitiditis: (Waterhouse Frederichson’s syndrome)
₋ Complications of Str. Pneumonie meningitis: subdural abscess and cranial
nerve
palsies

Management:
₋ Admission.
₋ IV A/b “3rd gen Cephalosporin (ceftriaxone) for 2 weeks.
₋ Add ampicillin if suspecting listeria (Immunocompromised + Age >55)
₋ Chloramphenicol can be used as second line for N. meningitidis
₋ Contacts are given Rifampicin