How to recognize meningeal symptoms? What are the symptoms of meningeal syndrome?

Modern medicine can eliminate or stop most existing pathological processes. Countless medications, physiotherapeutic procedures, etc. have been created for this. However, many therapy methods are most effective on early stages development of the disease. Among such pathological processes, meningeal syndrome can be distinguished. It is a complex of manifestations characteristic of irritation meninges. Among its causes are meningitis, meningism and pseudomeningeal syndrome. The last type is a consequence mental disorders, pathologies of the spine, etc. Inflammation of the meninges is characteristic only of the first 2 types, so it is recommended to find out what meningeal symptoms exist in order to identify the problem in time and begin treatment.

Meningeal syndrome, regardless of the cause, is expressed by certain symptoms. The first signs of the disease look like this:

• Feeling of aching throughout the body, as if you have a cold;
• General lethargy and fatigue even after sleep;
• Increased heart rate;
• Disturbances in the respiratory system;
• Temperature rise above 39º.

Gradually, meningeal symptoms (signs) appear more and more intensely and new ones are added to the previous signs:

• Manifestation of convulsive attacks. This symptom occurs mainly in children. For adults, its occurrence is considered rare;
• Adopting a meningeal position;
• Development of abnormal reflexes;
• The occurrence of a headache. This symptom is the main one and manifests itself extremely intensely. The pain intensifies mainly due to external stimuli, for example, light, vibration, sound, sudden movements, etc. The nature of the pain is usually acute and it can radiate to other parts of the body (neck, arms, back);
• Vomiting due to severe headache;
• Development of hypersensitivity (hyperesthesia) to light, vibration, touch, sounds, etc.
• Rigidity (petrification) of the muscle tissue of the back of the head.

The combination of these symptoms represents meningeal syndrome. The degree of manifestation and combination of symptoms may be different, since this pathological process has many causes. The presence of pathology is determined mainly through instrumental examination (lumbar puncture, MRI, etc.), but initially you should pay attention to its main manifestations.

Main features

During the examination, the doctor focuses on the following signs:

• Bekhterev's symptom. It is determined by lightly tapping the cheekbones. At the same time, the patient begins to have an attack of headache and facial expressions change;
• Brudzinski's sign. It is divided into 3 types:
  • Top form. If you put the patient on the couch and ask him to stretch his head to his chest, then along with this movement his legs will involuntarily bend at the knee joint;
  • Zygomatic shape. This sign is actually similar to Bekhterev's symptom;
  • Pubic shape. If you press on the pubic area, the patient will reflexively bend the lower limbs at the knee joint.
• Fanconi's sign. A person is unable to sit up independently if he is in a lying position (with his knees bent or fixed);
• Knik's sign. To check for this sign, the doctor applies light pressure around the corner. lower jaw. With meningeal syndrome, this action causes acute pain;
• Gillen's sign. The doctor checks this sign of meningeal syndrome by squeezing the quadriceps muscle on the front surface of the thigh. At the same time, the patient contracts the same muscle on the other leg.

Among other symptoms characteristic of inflammation of the meninges, two main manifestations of the pathological process described by Klunekamf can be distinguished.

The essence of the first sign is that when the patient tries to stretch his knee to his stomach, painful sensations, echoing in sacral region. A feature of the second symptom is pain when pressing on the atlanto-occipital membrane.

Kernig's symptom is considered one of the first manifestations of the pathological process. Its essence lies in the inability to independently straighten the lower limb if it is bent at an angle of 90º at the hip and knee joint. In children, such a meningeal sign may not appear at all. In infants up to 6-8 weeks and in children suffering from Parkinson's disease or myotonia, Kernig's sign is a consequence of excessively high muscle tone.

Hardening of the neck muscles

The muscle tissue located in the back of the head begins to harden with meningeal syndrome. This problem arises due to an abnormal increase in their tone. The occipital muscles are responsible for straightening the head, so the patient, due to its rigidity, cannot calmly bend his head, since along with this movement the upper half of the body is arched.

For people suffering from meningeal syndrome, a certain position is characteristic, in which the intensity of pain decreases:

• Hands pressed to the chest;
• Body arched forward;
• Intracted abdomen;
• Head thrown back;
• Lower limbs raised closer to the stomach.

Features of symptoms in children

In children, meningeal manifestations are predominantly a consequence of meningitis. One of the main signs of the disease is Lesage's symptom. If you press on the baby's armpits, his legs reflexively rise towards his stomach, and his head is thrown back a little. An equally important manifestation is Flatau's symptom. If the child tilts his head forward too quickly, his pupils will dilate.

Most characteristic feature for meningeal syndrome is a swollen fontanelle (the area between the parietal and frontal bones). Other symptoms may be less pronounced or absent. Among the frequently encountered signs are seizures, vomiting, fever, weakening of the muscles of the limbs (paresis), moodiness, irritability, etc.

In newborns, meningitis occurs as follows:

• Initially, the pathological process manifests itself with signs characteristic of a cold and poisoning (fever, vomiting, etc.);
• Gradually, children's appetite worsens. They become lethargic, moody and a little inhibited.

In the first days of development of the pathology, symptoms may be mild or completely absent. Over time, the child’s condition will worsen and neurotoxicosis with its characteristic neurological symptoms will appear.

Meningeal signs depend on the cause of the disease, but in general they are virtually the same. In most cases, the symptoms manifest themselves extremely intensely, but people, not knowing about a possible pathological process, do not go to the doctor until the last minute. In such a situation, the consequences are often irreversible, and in the case of a child, he may even die. That is why it is extremely important to know how the disease manifests itself in order to begin a course of treatment in a timely manner.

Clinical aspects differential diagnosis meningeal symptom complex (MSC) as the most common and important syndrome in practical infectology remains relevant to the present day. The main reasons for close attention to this syndrome are: an increase in the number of infectious and non-infectious diseases in which MSC occurs, a high frequency of complications of the pathology manifested by MSC, including deaths, untimely diagnosis and associated delayed treatment of the underlying pathology, leading to disability. Preclinical diagnosis of MSCs has become particularly relevant in recent years due to the increasing frequency of enterovirus, herpes, arbovirus, meningococcal and other neuroinfections.

Meningeal syndrome(MS) is irritation of nerve receptors in the pia mater due to its undifferentiated inflammatory process. Etiologically, the diagnosis (MS) is established based on a combination of the following clinical and pathogenetic syndromes: [ 1 ] infectious disease syndromes (general infectious symptoms: malaise, increased irritability, facial hyperemia, increased body temperature, shift in blood count to the left, bradycardia, then tachycardia and arrhythmia, increased breathing, in severe cases– Cheyne-Stokes breathing) [ 2 ] meningeal (meningeal) syndrome; [ 3 ] changes in cerebrospinal fluid.

MS underlies the clinical picture acute forms meningitis, regardless of their etiology. This syndrome, in combination with general cerebral and often local symptoms, can vary in the degree of severity of its individual components within the widest range. General cerebral symptoms are an expression of the reaction nervous system for infection due to intoxication, cerebral edema, damage to the soft meninges and impaired cerebrospinal fluid dynamics. The main elements of MS are: headache, vomiting, muscle contractures, changes in the cerebrospinal fluid.

However, it should be remembered that, despite the fact that MS is a symptom complex reflecting diffuse lesions of the membranes of the brain and spinal cord and MS can be caused by an inflammatory process (meningitis, menigoencephalitis), due to different microbial flora (in the case of inflammation, the etiological factor may be bacteria - bacterial meningitis, viruses - viral meningitis, fungi - fungal meningitis, protozoa - toxoplasma, amoeba), however, MS is caused by non-inflammatory lesions of the meninges. In these cases, the term “meningism” is used.

More about symptom complex M WITH:

MS consists of general cerebral and meningeal symptoms. General cerebral symptoms include very intense, painful headache of a bursting, diffuse nature, vomiting, often without preceding nausea, which does not bring relief to the patient; In severe cases, psychomotor agitation, delirium, hallucinations, convulsions are periodically replaced by lethargy and impaired consciousness (stupor, stupor, coma).

Meningeal symptoms themselves can be divided into 4 groups. To the 1st group General hyperesthesia refers to increased sensitivity to stimuli of the sensory organs: light (photophobia), sound (hyperacusis), and tactile. In severe cases of meningitis, the patient’s posture is very characteristic: the head is thrown back, the torso is extended as much as possible, incl. legs. Within these symptoms, the Fanconi phenomenon is characteristic: (tested with the patient lying on his back): in the presence of a positive symptom, the patient cannot sit up independently in bed with the knee joints extended and fixed; and Amoss’s symptom: the patient can sit in bed only leaning on both hands (in the “tripod” position) and cannot reach the knee with his lips. To the 2nd group meningeal symptoms include stiff neck, Kernig's sign, Brudzinski's symptoms upper, middle and lower (Kernig's symptom: the patient lies on his back with the leg bent at the hip and knee joints at an angle of 90°, due to the painful reaction it is not possible to straighten the limb in the knee joint up to 180°; Brudzinski's symptoms (tested with the patient lying on his back): distinguish between upper, middle and lower symptoms, upper: an attempt to tilt the head to the chest leads to flexion lower limbs in the knee and hip joints; middle (pubic): when pressing on the pubis, the legs bend (adduct) at the knee and hip joints; lower (contralateral): with passive extension of a leg bent at the knee and hip joints, involuntary flexion (pulling) of the other leg occurs in the same joints). Rigidity of the long back muscles causes the patient to be bent backward and unable to bend forward. In children, tension and protrusion of the large fontanel are also noted as a manifestation intracranial hypertension. When identifying meningeal symptoms, it is necessary to differentiate tonic muscle tension from false muscle rigidity caused by pain (myositis, radiculitis, etc.), which can simulate stiffness of the occipital muscles. To the 3rd group meningeal symptoms include reactive pain phenomena: pain when pressing on eyeballs, in places where branches emerge on the face trigeminal nerve, in places where large occipital nerves(Kerer points); on the anterior wall of the external auditory canal (Mendelian symptom); increased headache and painful grimace upon percussion of the zygomatic arches (Bechterew's symptom) and the skull (Pulatov's symptom). To the 4th group meningeal symptoms include changes in abdominal, periosteal and tendon reflexes: first their revival, and then an uneven decrease.

Remember! Meningism- the presence of meningeal symptoms in the absence of signs of inflammation in the CSF, with its normal cellular and biochemical composition. Meningism can occur in the following conditions (diseases): [ 1 ] irritation of the meninges and changes in CSF pressure: subarachnoid hemorrhage, acute hypertensive encephalopathy, occlusive syndrome due to space-occupying processes in the cranial cavity (tumor, parenchymal or intrathecal hematoma, abscess, etc.), carcinomatosis (sarcoidosis, melanomatosis) of the meninges, pseudotumor syndrome, radiation encephalopathy; [ 2 ] toxic process: exogenous intoxication (alcohol, overhydration, etc.), endogenous intoxication (hypoparathyroidism, malignant neoplasms etc.), infectious diseases that are not accompanied by damage to the meninges (influenza, salmonellosis, etc.); [ 3 ] pseudomeningeal syndrome (irritation of the membranes itself is absent, there is only symptomatology similar to meningeal signs, caused by other reasons: mental [paratonia], vertebrogenic [for example, spondylosis], etc.).

The diagnosis begins in the emergency room of an infectious diseases hospital. If there is no doubt about the presence of meningitis, which is confirmed by the available anamnestic and objective data, a decision is made to urgent implementation lumbar puncture. A diagnostic spinal tap should also be performed when unconscious sick. Spinal tap delayed if there is a suspicion of the absence of meningitis and the patient has a characteristic clinical triad (headache, vomiting, elevated temperature), stiff neck muscles, positive Kernig and Brudzinski symptoms. A similar picture is characteristic of meningism, which is based on toxic irritation of the meninges. Meningism can be observed in various common acute infectious diseases (influenza, ARVI, pneumonia, dysentery, viral hepatitis etc.) or during exacerbations of chronic diseases.

An additional sign of meningism can be the dissociation of meningeal syndrome, expressed between the presence of stiff neck muscles and upper symptom Brudzinski, and the absence of Kernig's sign and lower Brudzinski's sign. Differentiation of meningism from meningitis is possible only on the basis of examination of cerebrospinal fluid (CSF). During lumbar puncture, most patients have an increase in intracranial pressure(up to 250 mm water column), with normal cytosis and a slight decrease in protein (below 0.1 g/l). Characteristic feature meningism should be considered a rapid (within 1 - 2 days) disappearance of symptoms with a drop in temperature and a decrease in intoxication. The possibility of relapse of meningism with repeated diseases cannot be ruled out.

Conclusion:

Meningeal syndrome is caused by both an inflammatory process caused by various microbial flora (meningitis, menigoencephalitis) and non-inflammatory lesions of the meninges.

Some infectious and non-infectious diseases occur with the presence of meningeal symptoms, which in turn complicates the diagnosis correct diagnosis.

The diagnosis should be based on clinical data, taking into account the entire set of clinical, epidemiological and laboratory data, including consultations with specialists.

Remember!

Pathogenesis. There are 3 ways of infection of the meningeal membranes: 1. with open craniocerebral and spinal injuries, with fractures and cracks of the base of the skull, accompanied by liquorrhea; 2. contact, perineural and lymphogenous spread of pathogens to the meningeal membranes with existing purulent infection paranasal sinuses nose, middle ear or mastoid process, eyeball, etc.; 3. hematogenous spread.

TO pathogenetic mechanisms clinical manifestations meningitis include: 1. inflammation and swelling of the meninges; 2. discirculation in the cerebral and meningeal vessels; 3. hypersecretion cerebrospinal fluid and a delay in its resorption, which leads to the development of cerebral hydrocele and increased intracerebral pressure; 4. overirritation of the meninges and roots of the cranial and spinal nerves; 5. general effects of intoxication.

Diagnosis of meningitis is based on identifying the following syndromes:

General infectious - chills, fever, fever, lethargy (asthenia), tachycardia, tachycardia, inflammatory changes in the nasopharynx, gastrointestinal tract and peripheral blood (leukocytosis, increased ESR, etc.), sometimes skin rashes;

general cerebral - headache, vomiting, general hyperesthesia (to light, sound and touch), convulsions, disturbance of vital functions, changes in consciousness (psychomotor agitation, depression), bulging and tension of the fontanel;

meningeal (meningeal) - meningeal posture (“pointer dog posture”), rigidity neck muscles, Kernig’s, Brudzinski’s symptoms (upper, middle, lower), Lesage’s “suspension” symptom in children;

inflammatory changes in the cerebrospinal fluid - cell-protein dissociation - increased number of cells (neutrophils in purulent and lymphocytes in serous meningitis) and protein, but to a lesser extent than cell content.

– a symptom complex characteristic of damage to the cerebral membranes. It may have an infectious, toxic, liquor-hypertensive, vascular, traumatic, carcinomatous etiology. Manifested by headache, muscle rigidity, vomiting, hyperesthesia, algic phenomena. The diagnostic basis is made up of clinical data and the results of cerebrospinal fluid examination. Treatment is carried out according to the etiology with antibacterial, antiviral, antifungal, antiprotozoal agents, including symptomatic therapy, decrease in intracranial pressure.

Treatment of meningeal syndrome

Full-blown meningeal symptom complex requires treatment in a hospital setting. Therapy is carried out differentiated, taking into account the etiology and clinical manifestations, and includes the following areas:

• Etiotropic treatment. At bacterial etiology antibiotic therapy is prescribed with broad-spectrum drugs, viral - antiviral agents, fungal - antimycotics. Detoxification and treatment of the underlying disease are carried out. Before the pathogen is identified, etiotropic therapy is carried out empirically, after clarification of the diagnosis - in accordance with the etiology.
• Decongestant therapy. Necessary to prevent cerebral edema, aimed at reducing intracranial pressure. It is carried out with diuretics and glucocorticosteroids.
• Symptomatic therapy. Aimed at relieving emerging symptoms. Hyperthermia is an indication for the use of antipyretics, arterial hypertension is antihypertensive drugs, repeated vomiting - antiemetics. Psychomotor agitation is relieved by psychotropic drugs, and epileptic paroxysm is relieved by anticonvulsants.

Prognosis and prevention

In most cases, timely and correct treatment leads to the patient’s recovery. It may take several months residual effects: asthenia, emotional lability, cephalgia, intracranial hypertension. An unfavorable outcome is meningeal syndrome accompanying serious disease Central nervous system, fulminant course of the infectious process, oncopathology. Prevention of meningeal syndrome includes increasing immunity, preventing infectious diseases, injuries, intoxications, timely therapy of cerebrovascular and cardiovascular pathology. Specific prevention possible against meningococcal and pneumococcal infections.

Meningeal symptoms With purulent inflammation of the meninges, a lot has been described. These include neck stiffness, Kernig's sign, various options Brudzinski's symptom (upper, lower, buccal, pubic), Gillen's symptom. In addition, with meningitis, a number of pathological reflexes are observed, described by Babinsky, Oppenheim, Rossolimo, Gordon, Bekhterev and others.

To the most important symptoms Meningitis primarily affects neck stiffness and Kernig's sign. The appearance of these signs is due to reflex muscle contraction, which protects nerve roots(cervical and lumbar) from sprains. These symptoms are also observed when the meninges are irritated by any pathological process located in the cranial cavity, such as an abscess of the brain, cerebellum, and others. The severity of individual meningeal signs depends in such cases on the location of the abscess and the reaction of the meninges. The study of meningeal symptoms is usually carried out with the patient positioned on his back.

Muscle stiffness the back of the head can be expressed to a moderate or strong degree. In the first case, head movements are limited to the sides and forward, and in the second case, the head is thrown back. The study of this symptom is carried out with active and passive movement of the head. Rigidity of the neck muscles is easily detected by passively tilting the head forward until the chin touches the chest. With stiffness of the muscles of the back of the head, the chin does not touch the chest even in cases of moderate severity of this symptom, not to mention those cases when its intensity reaches a strong degree.

Definition Kernig's sign It is done like this: the leg is bent at a right angle at the hip, as well as at the knee, after which the examiner tries to fully straighten it at the knee joint. In this case, a reflex contraction of the flexors and pain occurs, preventing extension. When carrying out the Kernig experiment, sometimes the Edelman symptom, consisting of dorsal extension, appears simultaneously with it. thumb legs.

Brudzinski, as already said, many symptoms have been suggested. However, in case of inflammation of the meninges, they are content with studying only two of them: “upper” and “lower”. The first is revealed when examining the rigidity of the muscles of the back of the head, namely, when the head is passively tilted forward. At this time, automatic flexion of the lower limbs occurs at the hip and knee joints and pulls them towards the stomach.

Gillen's sign is caused by squeezing the quadriceps muscle with the examining hand, which, as is known, occupies the entire anterior and partly the lateral surface of the thigh. In response to compression of the mentioned muscle, a contraction of the same muscle on the other leg occurs.

To the signs inflammation of the meninges, indicating a sharp increase in irritation of the sensitive area, are the symptoms described by Kulsnkampf and Knick. Kuhlenkampf described two signs. One of them is that when strong bending knee to stomach pain occurs, radiating to the sacrum. The second is pain when pressing on the atlanto-occipital membrane. Let us add on our own that with meningitis, pain is also often observed when palpating the spinous processes of the cervical vertebrae. The Knik sign is when pressure on the area behind the angle of the mandible causes pain.
It must be emphasized that all sorts of manipulation on patients suffering from otogenic meningitis, regardless of their nature and intensity, cause discomfort and the corresponding reaction.

Pathological reflexes are caused by damage to the nervous system, namely the pyramidal tract. They are revealed by appropriate examinations of the foot; pathological reflexes on the hands are rarely observed and therefore do not have practical significance. The main ones are the symptoms of Babinsky, Rossolimo, Oppenheim, Bekhterev and Gordon. These reflexes have highest value V clinical practice. IN clinical picture diseases, sometimes all pathological reflexes are observed, or only part of them, most often the symptoms of Babinsky, Rossolimo and Oppenheim.

Separate forms of pathological reflexes or various combinations thereof are observed in severe cases of otogenic meningitis. Therefore, they have a certain significance in the neurological examination of these types of patients.
We will briefly discuss the identification method pathological reflexes. The starting position for their study is the patient's position on his back.

Video definition of meningeal symptoms

Table of contents of the topic "Stages and symptoms of otogenic meningitis":

The main, most constant and informative signs of irritation of the meninges are stiff neck and Kernig's sign. A doctor of any specialty should know them and be able to identify them.

Stiff neck muscles are a consequence of reflex increasing the tone of the head extensor muscles. When checking this symptom, the examiner passively flexes the head of the patient lying on his back, bringing his chin closer to the sternum. In the case of stiff neck muscles, this action cannot be performed due to the pronounced tension of the head extensors (Fig. 32.1a). An attempt to bend the patient's head can lead to the upper part of the body being raised along with the head, without causing pain, as happens when checking the radicular Neri sign. In addition, it must be borne in mind that rigidity of the extensor muscles of the head can also occur with pronounced manifestations of akinetic-rigid syndrome, then it is accompanied by other signs characteristic of parkinsonism.

Kernig's symptom, described in 1882 by St. Petersburg infectious disease doctor V.M. Kernig (1840-1917), received well-deserved wide recognition throughout the world. This symptom is checked as follows: the patient’s leg, lying on his back, is passively bent at an angle of 90° at the hip and knee joints (the first phase of the study), after which the examiner attempts to straighten this leg at the knee joint (the second phase). If a patient has meningeal syndrome, it is impossible to straighten his leg at the knee joint due to a reflex increase in the tone of the leg flexor muscles; with meningitis, this symptom is equally positive on both sides (Fig. 32.16). At the same time, it must be borne in mind that if the patient has hemiparesis on the paresis side due to changes in muscle tone, the Kernig sign may be negative. However, in older people, especially if they have muscle stiffness, there may be a misconception of a positive Kernig's sign.

Rice. 32.1. Identification of meningeal symptoms: a - stiff neck and upper Brudzinski’s sign; b - Kernig's symptom and lower symptom Brudzinsky. Explanation in the text.

In addition to the two main meningeal symptoms mentioned, there are a significant number of other symptoms of the same group that can help clarify the syndromic diagnosis.

So, possible manifestation meningeal syndrome is Lafora's sign(sharpened facial features of the patient), described by the Spanish doctor G.R. Lafora (b. 1886) as early sign meningitis. It can be combined with tonic tension of the masticatory muscles(trismus), which is characteristic of severe forms meningitis, as well as for tetanus and some

other infectious diseases accompanied by severe general intoxication. A manifestation of severe meningitis is a peculiar posture of the patient, known as “pointing dog” pose or “cocked hammer” pose: the patient lies with his head thrown back and his legs pulled up to his stomach. A sign of pronounced meningeal syndrome may be opisthotonus- tension in the extensor muscles of the spine, leading to tilting of the head and a tendency to overextend the spinal column. With irritation of the meninges, possible Bickel's sign, which is characterized by an almost permanent stay of the patient with bent V elbow joints, forearms, as well as blanket symptom- a tendency for the patient to hold the blanket pulled off him, which manifests itself at some patients with meningitis even in the presence of altered consciousness. The German doctor O. Leichtenstern (1845-I900) at one time drew attention to the fact that with meningitis, percussion of the frontal bone causes increased headache and general shuddering (Lichtenstern's symptom).

Possible signs of meningitis, subarachnoid hemorrhage or cerebrovascular insufficiency in the vertebrobasilar system are increased headache when opening the eyes and when moving the eyeballs, photophobia, tinnitus, indicating irritation of the meninges. This is meningeal Mann-Gurevich syndrome, described by the German neurologist L. Mann (I866-1936) and the domestic psychiatrist M.B. Gurevich (1878-1953).

Pressure on the eyeballs, as well as pressure introduced into the external ear canals fingers on their front wall is accompanied by severe pain and a painful grimace, caused by a reflex tonic contraction of the facial muscles. In the first case we're talking about O bulbofascial tonic symptom, described for irritation of the meninges G. Mandonesi, in the second - O meningeal Mendel's symptom(described as a manifestation of meningitis by the German neurologist K. Mendel (1874-1946).

Widely known meningeal zygomatic Bekhterev's symptom (V.M. Bekhterev, 1857-1927): percussion zygomatic bone accompanied by increased headache and tonic tension of the facial muscles (painful grimace) mainly on the same side.

A possible sign of irritation of the meninges may be severe pain upon deep palpation of the retromandibular points (Signorelli's symptom), which was described by the Italian doctor A. Signorelli (1876-1952). A sign of irritation of the meninges may be soreness of Kehrer's points(described by the German neurologist F. Kehrer, born in 1883), corresponding to the exit points of the main branches of the trigeminal nerve - supraorbital, in the area of ​​the canine fossa (fossa canina) and chin points, A also points in the suboccipital neck area, corresponding to the exit points of the greater occipital nerves. For the same reason, pain is also possible when pressure is applied to the atlanto-occipital membrane, usually accompanied by painful facial expressions (symptom Kullenkampf, described German doctor Kullencampf S, b. in 1921).

A manifestation of general hyperesthesia, characteristic of irritation of the meninges, can be recognized as dilation of the pupils, sometimes observed with meningitis, with any moderate painful effect (Perrault's symptom), which was described by the French physiologist J. Parrot (born in 1907), A also with passive

flexion of the head (pupillary Flatau's sign) described by the Polish neurologist E. Flatau (I869-1932).

An attempt by a patient with meningitis to bend his head so that the chin touches the sternum is sometimes accompanied by an opening of the mouth (Levinson's meningeal symptom).

Polish neuropathologist E. German described two meningeal symptoms: 1) passive flexion of the head of a patient lying on his back with his legs extended causes extension thumbs stop; 2) flexion at the hip joint of the leg straightened at the knee joint is accompanied by spontaneous extension of the big toe.

Widely known four meningeal symptoms of Brudzinsky, also described by the Polish pediatrician J. Brudzinski (1874-I917):

1) buccal symptom - when pressing on the cheek under the zygomatic arch on the same side, the shoulder girdle is raised, the arm is bent at the elbow joint;

2) upper symptom - at trying to bend the head of a patient lying on his back, i.e. when trying to identify stiff neck muscles, his legs involuntarily bend at the hip and knee joints, pulling towards the stomach; 3) middle or pubic symptom - at pressing a fist on the pubis of a patient lying on his back, his legs bend at the hip and knee joints and are pulled towards the stomach; 4) lower symptom - an attempt to straighten the patient’s leg at the knee joint, which was previously bent at the hip and knee joints, i.e. checking the Kernig sign, accompanied by pulling the other leg to the stomach (see Fig. 32.16).

Involuntary bending of the legs at the knee joints when the examiner tries to lift the upper body of a patient lying on his back with his arms crossed on his chest is known as meningeal Kholodenko's sign(described by the domestic neurologist M.I. Kholodenko, 1906-1979).

The Austrian doctor N. Weiss (Weiss N., 1851 - 1883) noticed that in cases of meningitis, when Brudzinsky and Kernig symptoms are caused, spontaneous extension of the 1st toe occurs (Weiss symptom). Spontaneous extension of the big toe and sometimes fan-shaped divergence of the rest her fingers can also occur when pressing on the knee joint of a patient with meningitis lying on his back with his legs extended - this is meningeal Strumpl's sign, which was described by the German neurologist A. Strumpell (1853-1925).

The French neurologist G. Guillain (1876-1961) found that when pressure is applied to the anterior surface of the thigh or compression of the anterior thigh muscles, a patient with meningitis lying on his back involuntarily bends at the hip and knee joints, the leg on the other side (meningeal Guillain's sign). Domestic neurologist N.K. Bogolepov (1900-1980) drew attention to the fact that when inducing Guillain’s symptom, and sometimes Kernig’s symptom, the patient experiences a painful grimace (Bogolepov's meningeal symptom). Extension of the big toe when checking Kernig's sign as a manifestation of irritation of the meninges (Edelman's symptom) described by the Austrian physician A. Edelmann (1855-I939).

Pressure on the knee joint of a patient sitting in bed with his legs extended causes spontaneous flexion of the knee joint of the other leg - this Netter's sign- a possible sign of irritation of the meninges. When fixed to bed knee joints When the patient is lying on his back, he cannot sit up, because when he tries to do this, his back reclines

back and an obtuse angle is formed between it and the straightened legs - menin-] sebaceous symptom Meitus.

The American surgeon G. Simon (I866-1927) drew attention to the possible disruption of the correlation between respiratory movements in patients with meningitis chest and diaphragm (Simon's meningeal sign).

In patients with meningitis, sometimes after irritation of the skin with a blunt object, pronounced manifestations red dermographism leading to the formation of red spots (Trousseau spots). This symptom was described by the French physician A. Trousseau (1801 - 1867) as a manifestation of tuberculous meningitis. Often in the same cases, patients experience tension in the abdominal muscles, causing abdominal retraction (symptom of “scaphoid” abdomen). IN early stage of tuberculous meningitis domestic doctor Sirnev described the increase lymph nodes abdominal cavity and the resulting high position of the diaphragm and manifestations of spasticity of the ascending colon (Syrnev's symptom).

When a child with meningitis sits on the potty, he tends to lean his hands on the floor behind his back (meningeal potty symptom). Positive in such cases is also "kissing the knee" phenomenon: if the meninges are irritated, the sick child cannot touch his knee with his lips.

For meningitis in children of the first year of life, the French doctor A. Lesage described "suspension" symptom: if a healthy child of the first years of life is taken under the arms and raised above the bed, then he “minces” with his legs, as if looking for support. A child suffering from meningitis, finding himself in this position, pulls his legs towards his stomach and fixes them in this position.

The French doctor P. Lesage-Abrami noted that children with meningitis often experience drowsiness, progressive emaciation and cardiac arrhythmias (Lesage-Abrami syndrome).

Concluding this chapter, we repeat that if the patient has signs of meningeal syndrome, in order to clarify the diagnosis, a lumbar puncture should be made with the determination of cerebrospinal fluid pressure and subsequent analysis of the CSF. In addition, the patient should undergo a thorough general somatic and neurological examination, and in the future, during the treatment of the patient, systematic monitoring of the therapeutic and neurological status is necessary.

CONCLUSION

By completing the book, the authors hope that the information presented in it can serve as a basis for mastering the knowledge necessary for a neurologist. However, the book on general neurology offered to your attention should be considered only as an introduction to this discipline.

The nervous system provides integration various organs and tissues into a single organism. Therefore, a neurologist is required to have broad erudition. He must be V is oriented to one degree or another in almost all areas of clinical medicine, since he often has to participate in the diagnosis of not only neurological diseases, but And in determining the essence of pathological conditions that doctors of other specialties recognize as beyond their competence. Neurologist

in everyday work he must also prove himself as a psychologist who knows how to understand the personal characteristics of his patients, the nature of the influences on them exogenous influences. A neurologist, to a greater extent than doctors of other specialties, is expected to understand the mental patient conditions, features of the social factors influencing them. Communication between a neurologist and a patient should, whenever possible, be combined with elements of psychotherapeutic influence.

The scope of interests of a qualified neurologist is very wide. It must be borne in mind that damage to the nervous system is the cause of many pathological conditions, in particular dysfunction of internal organs. At the same time, neurological disorders that appear in a patient are often a consequence, a complication of his existing somatic pathology, common infectious diseases, endogenous and exogenous intoxications, pathological effects on the body of physical factors and many other reasons. So, acute disorders cerebral circulation, in particular strokes, are usually caused by complications of diseases of the cardiovascular system, the treatment of which, before the onset of neurological disorders, was carried out by cardiologists or general practitioners; chronic renal failure is almost always accompanied by endogenous intoxication, leading to the development of polyneuropathy and encephalopathy; many diseases of the peripheral nervous system are associated with orthopedic pathology etc.

The boundaries of neuroscience as a clinical discipline are blurred. This circumstance requires a special breadth of knowledge from a neurologist. Over time, the desire to improve the diagnosis and treatment of neurological patients led to a narrow specialization of some neurologists (vascular neurology, neuroinfections, epileptology, parkinsonology, etc.), as well as to the emergence and development of specialties occupying a borderline position between neurology and many other medical professions (somatoneurology -gia, neuroendocrinology, neurosurgery, neuroophthalmology, neurootiatria, neuroradiology, neuropsychology, etc.). This contributes to the development of theoretical and clinical neurology and expands the possibilities of providing the most qualified care to neurological patients. However, a narrowed profile of individual neurologists and, even more so, the presence of specialists in disciplines related to neurology are possible only in large clinical and research institutions. As practice shows, every qualified neurologist must have broad erudition, in particular, be oriented in problems that in such institutions are studied and developed by specialists of a narrower profile.

Neuroscience is in a state of development, which is facilitated by achievements in various fields of science and technology, improvement of the most complex modern technologies, as well as the successes of specialists in many theoretical and clinical medical professions. All this requires from a neurologist constant increase level of knowledge, in-depth understanding of the morphological, biochemical, physiological, genetic aspects of pathogenesis various diseases nervous system, awareness of advances in related theoretical and clinical disciplines.

One of the ways to improve the qualifications of a doctor is periodic training in advanced courses, conducted on the basis of the relevant faculties of medical universities. At the same time, the first

foamy value has independent work with special literature in which you can find answers to many questions that arise in practical activities.

To facilitate the selection of literature that may be useful to a novice neurologist, we have provided a list of some books published in Russian over the past decades. Since it is impossible to embrace the immensity, it does not include all literary sources reflecting the problems that arise for a neurologist in practical work. This list should be considered conditional, indicative, and as necessary it can and should be replenished. Special attention It is recommended to devote attention to new domestic and foreign publications, and it is necessary to monitor not only published monographs, but also journals that relatively quickly bring to the attention of doctors the latest achievements in various fields of medicine.

We wish our readers further success in mastering and improving knowledge that will contribute to the improvement of professional qualifications, which will undoubtedly have a positive impact on the effectiveness of work aimed at improving the health of patients.