Meningitis – symptoms and types
Meningitis is an inflammatory disease of the meninges which has serious course and often leaves a lasting negative effects on the health. All types of meningitis have specific characteristics according to the causes and course in children and adults.
In most cases is secondary leptomeningitis that arises in the course of a pulmonary form of tuberculosis. More often affects children and adolescents. There are morphological differences between untreated acute and chronic treated tuberculous leptomeningitis. The disease begins secretly, insidiously, creeping and conducts for days and weeks. Gradually occurs progressive increase in symptoms and is late for treatment.
Symptoms in tuberculous meningitis
- poor general condition
- night sweating
- loss of weight
- subfebrilis temperature
- paresis of eye muscles
- abnormal reflexes
- change in consciousness
CSF – syndrome in tuberculous meningitis
- increased protein
- increased cholesterol
- reduced glucose and chorides
- pleocytosis – 90% of the cellular components are lymphocytes
In tuberculous meningitis are affected basal structures (the base of the brain). Vessels are found with hyperemia and jelly (large amount of fibrin) matter between brain tissue and meninges. Part of the exudate is directed to sulcus lateralis, because it finds a place to flow. There may be caseous necrosis, endarteritis and panarteritis changes, but tubercles are rare. Microscopicaly are detected large amounts of fibrin and lymphocytes (white blood cells are single) in leptomeninges.
In suspection of tuberculous meningitis should immediately begin a treatment for tuberculosis. With timely and proper treatment recovery occurs in 90% of cases.
Otherwise, tuberculous meningitis can become chronic. Massive fibrosis is developed at the base of the brain with blockage of CSF system, hydrocephalus (internal), compression of the vascular trunks, spasm, thrombosis, anemic infarction (stroke). There is severe pain due to damage of nerves, including nervus oculomotorius. From there follow the changes is vision such as double vision.
This meningitis develops in tertial syphilis and is called neurolues. It is localized predominatly in the frontal lobes. Clinical course is with severe mental disorders and an increase in CSF protein, luetic positive serological reaction and low number of cells. The frontal lobes of the brain are reduced in size, brain folds are reduced in size, ependima of the ventricles becomes grainy, soft meninges are thickened, with reduced transparency and gummous adhesions. Microscopic are found perivasal mononuclear infiltrates, endarteritis obliterans, fibrosis.
They are purulent leptomeningitis and are caused by meningococci (epidemic leptomeningitis), pneumococci, streptococci, staphylococci, etc. Here is a typical convexity location (on the surface of a large brain hemispheres) with one exception – the epidemic meningococcal meningitis.
Affects above all children and adolescents, less adult. Meningococcal meningitis is a primary leptomeningitis that may affect the base of the brain, but its characteristic is purulent collection (not jelly), which is rich in leukocytes, edematous fluid and perdiapedesis bleeding. Large brain hemispheres are covered by a lid of thin purulent yellow pus and can be developed the most severe complication – meningococcal sepsis (Waterhouse- Frederiksen syndrome). Occurs deepening shock due to bleeding into the adrenal glands and confluent cutaneous bleeding. Other purulent meningitis are secondary and engage convexity of the large hemispheres.
Often affects newborns, infants, young children and adults in age 40. It occurs simultaneously or at the end of pneumonia, otitis media or sinusitis. In patients with multiple myeloma is often found pneumococcal infections. It is characterized by large amounts of neutrophils and fibrin exudate and high lethality (poor prognosis).
Staphylococcal meningitis may develop as a complication of pyoderma in children.
Serous meningitis can be caused by viruses, fungi ad protozoa, but they can develop in non – infectious diseases – brain tumors, lead poisoning. In 60 – 70% of serous meningitis cases are caused by ECHO virus. The surface of brain is with severe hyperemia, but no purulent collection. CSF is found increased cell number – 100% lymphocytes – hence the name lymphocitic meningitis.
Serous meningitis symptoms:
- severe headache
- light afraid
- lack of appetite
- neck stiffness
- seizures (rare)