Brain shells. Source: Ru-BabyHealth.ru.

Meningheal symptoms (they are meningeal signs)- these are symptoms of irritation brain shells and the reason for the formation of a symptom complex, referred to in neurological practice by meningel syndrome.

Meningeal syndrome under meningitis

High significance of its timely detection during meningitis.

Its presence is "Red Flag" for a doctor and a matter of exclusion or confirmation of its infectious nature.

For the first time, meningitis symptoms described the hippocrates, but the first documented outbreak of the disease arose in Geneva (1805g). Later (1830) she broke out in North America, and after 10 years in Africa. IN Russian Empire Epidemic meningitis was recorded in 1863 in Kaluga, in 1886. in Moscow.

Meningkeal syndrome covers the symptoms (C-We) damage to the brain shells of both inflammatory and infectious and non-inflammatory nature.

Causes of inflammatory infectious damage:

• Bacteria (meningococcus, pneumococcus, streptococci group B, Listeria, M.TUBERCULOSIS, Hemophilic wand);
• Viruses (Enetheroviruses, Arboviruses, Cytomegalovirus, HSV Type 1, Type 2);
• Fungi (candida, cryptococcus);
• Spirochetes (pale treponema, borrelia, leptospira).

The reasons

Under what pathological conditions, brain shells irritate:

• Hemorrhage into the brain shell due to acute brain blood supply to hemorrhagic type (), cranial injury (intracranial blood circulation: subarachnoidal,);
• High intracranial pressure (VCHD) due to hydrocephalus, abscess - any volume formations (cysts, tumor);
• Inxication: a) exogenous: alcohol, abuse of various chemicals, work in paints and varnishes; b) endogenous: hypoparatyosis, the body poisoning by protein exchange products due to the impaired kidney function.
• Metastasis tumors in brain shells
• Meningitis of any origin. Than dangerous

Symptoms of brain shell irritation

• headacheaccompanied by nausea / vomiting, more often spilled and more pronounced in the frontal and occipital part
• muscle rigidity, C-we, Cernig and Brudzinsky
• increase sensitivity to external stimuli (sound, light, etc.),
• violations heart Rhythm, (with the development of both tachy, and bradycardia)
• pose of "Legal Dog" (the torso stretches, the head throws out, "Pondoid" belly is drawn, the hands are pressed against the chest, and the legs are attracted to the abdomen area - an involuntary position of the body).
• violation of consciousness - in severe cases
• reduced / lack of tendon and abdominal reflexes

Vomiting (not related to meals) and bradycardia- due to irritation wandering nerve With its nuclei or center of vomiting the mesh substance of the oblong brain.

Intensive headache, tachycardia, vomiting - general-in-country symptoms indicating an increased GFD and a change in the composition of the liquor.

Both variants of heart rate disorders: tachycardia and bradycardia are found in irritation of cerebral shells.

For timely diagnosis In neurology, the doctor must know the meningeal syndrome - to imagine what it is and how to see it when examining the patient. If the meningeal signs are negative, diagnostic search for the causes of the disease continues in other directions.

If they are positive, the following signs are detected when inspected:

• Muscle Rigid Network Because of the tense muscles of the neck from behind during the doctor's attempt to bend the patient's head forward. The characteristic threading of the head appears. Any attempt to change the fixed pose causes pain. At the same time, the distance from the chin to the sternum is denoted by centimeters or in the diameters of the index finger of an adult (PP).
• Symptom (s-M) Kernig - An important feature, emerging early: the patient who lies on the back, spend flexion at an angle of 90 degrees in the hip and knee joints and are trying to completely break it in the knee. But pain and reflex irritation of the leg flexors that prevent the extension will appear.
• Symptoms of Brudzinsky:

- Sad - spend pressure on the cheek of the study and bending the hands in the elbows is absolutely involuntarily, also the patient produces shrugs.

- Upper - the doctor is trying to bend his head to the patient and at the same time the legs of the studied make bending and pressed against the stomach.

- The average - during pressure on the pubic area of \u200b\u200bthe patient's legs make bending.

- Nizhny - Explore flex to the patient foot in 2 joints (knee, hip), the other foot repeats movements.

• S-M Bekhtereva - When tapping a finger on the zilly bone, a sharp headache and pain grimace - a reduction in the mimic muscles on the same part of the person.
• S-M Gordon - The doctor worst the nakedness of the patient and squeezes it much, as a result of this, the thumb squeezes on his leg, the fingers of the hands diverge in different directions.
• C-M Guillana - The doctor presses on / squeezes the patient's thigh surface (front) and the leg on the other hand makes flexion in the knee.
• C-M Corera: When palpation of output points trigeny nerve The pain is enhanced.
• S-M Herman: The explored tilts the head of the studied forward and in a patient who lies on his back with straight legs, the thumb is extension.
• S-M Lafora: Face features sharpen.
• S-M Flatau: Pupils expand when trying to explore the head of the head under study.
• C-M Bickel: The investigated is asked to bend hands in the elbows and do not resist the explore, however, the passive extension of hands is not able to spend due to resistance.
• S-M Mandanese - Muscles of the face are strained when paltering on the eyeballs.
• S-M Levinson: When the patient is trying to make a tilt head forward, his mouth opens.

Meningheal symptoms (signs) in children and newborns

There are certain features in the manifestation of meningeal symptoms in children. As Bekhterev noted that the newborn C-M Kerniga is physiological. He arises a few hours from birth, and the first month of life is pronounced, and disappears only by the end of the 3rd (rarely 6th) of the month.

In children under 3 years old, a pronounced picture of meningeal syndromes is rarely found. On the presence of headaches in infants can be judged only by the general concern of the child, crying (monotonous unfortunate or screaming during sleep). Vomiting joins (involuntary or when changing the position of the body). TO characteristic symptoms Increased HBF in infants relates to the protrusion, the tension of the spring, the weak ripple of them / its absence.

In children under 3, as well as in adults, there is a rigidity of the occipital muscles, C-M Kerniga, Brudzinsky. Distinctive is a symptom of a lesge or "hanging": the child takes over the axillary depressions, support the heads of the back at the rear, lift it up (is positive if there is an executive tightening of the legs to the stomach and long-term fixation of them in a bent condition). Meningheal C-We have for more than 3 years no other than the same syndromes in adults.

Meningism: Causes and Clinic

IN clinical practice The neurologist's doctor exists a lot of reasons for identifying meningeal symptoms in the absence of signs of inflammation from spinal fluid.

This phenomenon is called meningism. Often, his reason is to increase the production of liquor or an increase in the concentration of substances in it capable of irritating brain shells without causing their inflammation. Meningism is observed at, in the case of mechanical irritation of the cerebral shells.

Clinical manifestations are the same as with the above-mentioned overall symptoms in meningheal syndrome, with the only difference that it will be less pronounced and faster regress with positive dynamics during the underlying disease. For example: decrease in intracranial pressure in the syndrome of its increase ( intracranial hypertension), removal from the body of an excessive toxins (detoxification). When meningitis, for example, meningeal signs do not regress so quickly.

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Regards, Neurologist Postnikov Alexander Yuryevich

Meningheal symptoms must know every doctor. This group of symptoms is essential in neurology. Meningal symptoms occur when the brain shell irritation occurs. An irritation usually appears as a result of meningitis, but it can be triggered, for example, hemorrhage inside the brain or the collapse of the tumor. Meningial signs are of great importance for diagnosing the disease. With the slightest inflammation of the patient's meningeal shells, it is necessary to examine, especially for children. Today, medicine has identified more than 30 symptoms. Meningkeal signs are usually called by the author who has opened it. The most significant symptoms will be discussed below.

The symptoms of Kerniga is characteristic not only for children and patients who develop meningitis, but also for people with problems in the knee joints. Meningheal Kerniga syndrome allows you to establish an accurate diagnosis in children and adults. The essence of this syndrome is that when flexing and extending the knee, hip joint (with the help of the doctor) there is no full straightening of the leg. This meningeal syndrome in 2 stages is investigated.

At first, the doctor flexs the feet of the patient lying on the stomach, and then weakens the pressure and let go of the leg, which begins passively blending.

In healthy children and adults, this syndrome does not manifest itself, and the leg quietly returns to its original position. Kerniga syndrome allows not only to diagnose the presence of meningitis, but also to determine to what the brain is affected by infection. In addition, it is possible to determine the forecast of the pathological change in the nervous tissue, and in what dynamics the disease is developing.

Other options

The meningeal shront syndrome is manifested by a slowly progressive lower spastic paraplegia. The function of the hands is saved. Capor innervation remains preserved. In the later stages, urinary incontinence can manifest. Sometimes decline pain sensations. Checked with a symptom by pressing the knee joint. The inflammation of the brain shell is diagnosed if the fingers are disclosed by fan, as well as in spontaneous extension thumb legs. When the form of pathology is complicated, the symptoms can join the hearing loss, cerebelchik ataxia, ichthyosis, etc.

The meningeal hyena syndrome in children and adults is manifested by the following symptoms:

1. Catarial inflammation of the respiratory tract.
2. Total weakness, fatigue, malaise.
3. Increase body temperature to limit values.
4. Failure in the functioning of the gastrointestinal tract.

Meningheal Hyien syndrome in children and adults at the initial stage is manifested total weakness In the muscles of the limbs, which indicates the destruction of nerve cells. In the later stages of development of pathology, loss of sensitivity in the limbs is joined. Another meningeal symptom is called Mendel's symptom. The characteristic features of the development of the pathological condition are that in children or adult patient there is a stupid pain in the field of appendix. Nausea and vomiting may develop. In the language may appear white flag. The next meningeal sign is the symptom of Flatau. It is manifested by the symptom in the expansion of the patient's pupils, when it is passively or intensively flexing his head.

Checking meningeal symptoms is very important. The symptoms of Brudzinsky checks not only the target organ, but also all systems, because usually the defeat concerns the brain shells and the whole organism as a whole. The signs of Burudzinsky are checked like this:

1. Top sign. The patient must lie on the back and try to get the chin to the chest. If the inflammation of the shell is present, then he involuntarily bends his leg in the knee and the hip joint.
2. Middle feature. The patient is slightly pressed on the pubis. Inflammation is present if he attracted his legs to the stomach.
3. The lower sign is checked as the symptom of Kernig.
4. Script. The patient is pressed into the area under the cheek, and if the inflammation of the brain shells is present, then the sick person will bend a hand or raise a brush.

In practice, these features introduced the Polish doctor Joseph Brudzinsky. Since the beginning of the 20th century, they are standard in diagnosing meningitis in children and adults.

Another meningeal syndrome, allowing to diagnose meningitis, is the rigidity of the occipital muscles. You can check it out by flexing the patient's head from the lying position. The doctor is trying to attract the patient's head to chestBut if there is a rigidity (high muscle tone), then do it will not work. When checking, lifting body can be seen. The rigidity of the occipital muscles is of great importance in the diagnosis of hemorrhage into the brain and meningitis.

The next symptom is the pose of a lying dog. With severe lesions nervous system Violates the work of the whole organism.

Under the meningkeal syndrome, an increase in muscle tone occurs, and the patient acquires a pose of a lying dog, or otherwise the pose of the cuckoo. This postal testifies that meningitis proceeds extremely difficult. The symptom is unfavorable.

Opistotonus, bubble muscle trium

Opaytotonus is a pose that characterizes back head, deflection in the spinal column and the flexural limbs. A person takes such a posture with inflammation of brain shells, meningitis, tumors, tetanus or hemorrhagic stroke. Rarely such a pose of a person occupies when he has a hysterical seizure. In children, opistotonus is manifested when purulent meningitis Or tetanus, testifies to brain damage. Another symptom of inflammation of the brain shells is the triumm of chewing muscles. He manifests itself with the spasm of these muscles, the inability to move freely by the jaw. Symptom The pot usually manifests itself in children who are sick bacterial meningitis. When the kid sits on a pot, he rapidly tries to rely on the floor behind the back.

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He does it in order to avoid tensioning muscles in the back of the head. The symptom of Levinson is very important in the diagnosis of viral, bacterial and tuberculous meningitis. Checked symptom is very simple. The patient when trying to pull his head to the chest involuntarily opens his mouth. This feature is not specific and applied in difficult cases. In case of serous, tuberculosis, viral meningitis is manifested by a symptom of a bickel. Its development occurs when there is a serious inflammation of the brain shells. Sometimes the symptom of the Bickel is manifested in brain hemorrhage. The sign is expressed constantly bent in his elbows. Also, the patient constantly wants to keep the blanket tied with it. This condition remains the same, even if the patient is in a feverish state.

Thanks to all the above symptoms, it is possible to diagnose the pathology dangerous to human life and prescribe treatment. After all, on time, the treatment launched is a prosperous outcome of 80%.

Clinical aspects differential diagnosis Meningkeal symptom complex (MSC) as the most frequent and important syndrome of practical infratology retain their relevance to the present. The main reasons for close attention to this syndrome are: an increase in the number of infectious and noncommunicable diseases under which MSC arises, a high frequency of complications of pathology, manifested by MSK, including lethal outcomes, untimely diagnostics and its delayed therapy of the main pathology, leading to disabled. A special relevance acquires the preclinical diagnosis of MSCs in recent years due to the increasing frequency of enterovirus, herpetic, arbovirus, meningococcal other neuroinfections.

Meningleal syndrome (MS) is irritation of nervous receptors in a soft cerebral shell due to its undifferentiated inflammatory process. The etiologically diagnosis (MS) is established on the basis of a combination of the following clinical and pathogenetic syndromes: [ 1 ] Infectious disease syndromes (common symptoms: indisposition, increased irritability, face hyperemia, body temperature, levion shift left, bradycardia, then tachycardia and arrhythmia, breathing, in severe cases - Chein-Stokes breathing) [ 2 ] meningeal (shell) syndrome; [ 3 ] Changes in the spinal fluid.

MS underlies clinical picture acute forms meningitis, regardless of their etiology. This syndrome in combination with general-year, and often local symptoms can vary by the degree of severity of its individual components in the widest limits. The total-selling symptoms are an expression of the reaction of the nervous system on an infection due to intoxication, brain edema, lesions of soft cerebral shells and disorders of liquorodynamics. The main elements of the MS are: headache, vomiting, muscle contractures, changes on the side of the spinal fluid.

However, it should be remembered that, despite the fact that MS is a symptom complex, reflecting diffuse lesions of the shells of the head and spinal cord and ms may be due to the inflammatory process (meningitis, meningoenetsopal), due to various microbial flora (in the case of inflammation, the etiological factor can be bacteria - bacterial meningitis, viruses - viral meningitis, mushrooms - fungal meningitis, simplest - toxoplasm, amosa), however MS to be due to non-inflammatory lesions of the brain shells. In these cases, the term "Meningness" consumes

More about symptom complex MFROM:

MS develops from the general-selling and actual meningeal symptoms. The total-selling symptoms include a very intense, painful headache of the operating, diffuse character, vomiting, often without preceding nausea, not bringing a sick relief; For severe course Psychomotor excitation, nonsense, hallucinations, convulsions, periodically replacing lethargy and violation of consciousness (stupidity, copor, coma).

Actually, meningeal symptoms can be divided into 4 groups. To the 1st group Overall hyperesthesia includes increased sensitivity to the stimulus of the senses of the light (light-free), sound (hyperactus), tactile. With a serious flow of meningitis, the patient's posture is very characteristic: the head is trapped back, the torso is rapidly dispersed, incl. legs. As part of these symptoms, the phenomenon of Fanconi: (is checked in the position of the patient lying on the back): if there is a positive symptom of the patient, it cannot independently sit in bed during dispersed and fixed knee joints; And the symptom of Amosa: the patient can sit in bed only leaning on both hands (in the pose of the "tripod") and can not get the knee lips. To the 2nd group Meningkeal symptoms include the rigidity of the occipital muscles, the symptom of Kerniga, the symptoms of the Brudzinsky top, the middle and lower (symptom of Kerniga: The patient lies on the back with a bent in the hip and knee joints at an angle of 90 °, due to the painful reaction, it is not possible to straighten the limb in knee joint up to 180 °; The symptoms of the Brudzinsky (checked in the patient lying on the back): distinguish the upper, medium and lower symptoms, the top: attempt to tilt the head to the chest leads to the bending of the lower extremities in the knee and hip joints; Middle (pubic): When pressing on the puberty, bending (bringing) legs in the knee and hip joints occurs; Nizhny (contralateral): with a passive extension of the leg bent in the knee and hip joints, there is an involuntary bending (pulling) another leg in the same joints). The rigidity of the long muscles of the back leads to the fact that the patient is curved by the kice and cannot get bend forward. Children also have the tension and protrusion of a large springs as a manifestation of intracranial hypertension. In identifying meningeal symptoms, it is necessary to differentiate the tonic muscle tension from the false muscle rigidity due to the pain (mositis, radiculites, etc.), which can simulate the rigidity of the muscle muscles. To the 3rd group Meningkeal symptoms include reactive pain phenomena: soreness when pressing on the eyeballs, in places of exit on the face of the branches of the trigeminal nerve, in the locations of large occipital nerves (the point of the kerier); on the front wall of the outdoor auditory passage (symptom of Mendel); Strengthening headaches and painful grimace with perculse arc percussion (symptom of behterev) and skulls (symptom of Pulatov). To the 4th group Meningkeal symptoms include changes in abdominal, periobal \u200b\u200band tendon reflexes: initially their revival, and then an uneven decline.

Remember! Meningism - the presence of meningeal symptoms in the absence of signs of inflammation in the CMF, during its normal cellular and biochemical composition. Meningism can be in the following states (diseases): [ 1 ] Brain shell irritation and Changing the PRESSION: Subarachnoid hemorrhage, acute hypertensive encephalopathy, occlusive syndrome with volumetric processes in the skull cavity (tumor, parenchymal or subordinate hematoma, abscess, etc.), carcinomatosis (sarcoidosis, melanomatosis) of brain shells, pseudo-pumping syndrome, radiation encephalopathy; [ 2 ] Toxic process: exogenous intoxication (alcoholic, hyperhyrastration, etc.), endogenous intoxication (hypoparathyroidism, malignant neoplasms, etc.), infectious diseases that are not accompanied by the lesion of brain shells (flu, salmonelosis, etc.); [ 3 ] Pseudomeningleal syndrome (there is no shell irritation itself, there is only a similar symptomatic symptomatic signs, due to other reasons: mental [paraty], vertebrogenic [for example, spondylosis], etc.).

The diagnosis is starting in the reception room of the infectious hospital. If there is no doubt in the presence of meningitis, which is confirmed by the existing anamnestic and objective data, a decision on the urgent lumba puncture is made. The diagnostic spinal puncture should also be carried out with the unconscious state of the patient. The spinal point puncture displays, if there is a suspicion of the absence of meningitis if there is a characteristic clinical triad in a patient (headache, vomiting, increased temperature), muscle rigidity, the nape, positive symptoms of Kerniga, Brudzinsky. A similar picture is characteristic of meningism, which is based on toxic irritation of the brain shells. Meningness can be observed with different common sharp infectious diseases (influenza, ORVI, pneumonia, disinterry, viral hepatitis et al.) Or with exacerbations of chronic diseases.

An additional feature of meningism can serve as the dissociation of menigial syndrome expressed between the presence of rigidity of the occipital muscles and upper symptom Brudzinsky, and the lack of a symptom of Kerniga and the lower symptom of Brudzinsky. Differentiation of meningism from meningitis is possible only on the basis of the study of the spinal fluid (SMG). With lumbal puncture, most patients are determined by an increase in intracranial pressure (up to 250 mm of water. Art.), Under normal cytosis and a minor reduction of protein (below 0.1 g / l). A characteristic feature of meningism should be considered rapid (within 1 - 2 days) the disappearance of symptoms when the temperature drops and reduce intoxication. The possibility of recurrence of meningism during repeated diseases is not excluded.

Output:

The meningeal syndrome is due to both an inflammatory process caused by various microbial flora (meningitis, meningoenetsephalitis) and non-aggregative lesions of the brain shells.

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

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

Remember!

Pathogenesis. There are 3 ways of infection of meningeal shells: 1. With an open beacon and spinal injuries, during fractures and cracks of the base of the skull, accompanied by liquor; 2. Contact, perinancial and lymphogenic distribution of pathogens for meningeal shells at an existing purulent infection putty sinuses nose, middle ear or prepar process, eyeball, etc.; 3. Hematogenic distribution.

To pathogenetic mechanisms clinical manifestations meningitis are related: 1. Inflammation and cerebral swelling; 2. Discirculation in brain and shell vessels; 3. HyperSectionage of the cerebrospinal fluid and the delay of its resorption, which leads to the development of brain water and an increase in intracereblock pressure; 4. Refoloration of brain shells and cereal and spinal nerves; 5. The overall impact of intoxication.

Meningitis diagnostics is based on the identification of the following syndromes.:

General oxidizing - chills, heat, temperature rise, lethargy (asthenia), tachycardia, tachypal inflammatory changes from the nasopharynx, gastrointestinal tract and in peripheral blood (leukocytosis, an increase in ESP, etc.), sometimes skin rashes;

general-selling - headache, vomiting, total hyperesthesia (to light, sound and touch), convulsions, violation of vital functions, change of consciousness (psychomotor excitation, depression), swelling and springs;

shell (meningeal) - meningeal posture ("Pose of Legal Dog"), the rigidity of the cervical muscles, the symptoms of Kerniga, the Burutsinsky (top, middle, bottom), the symptom of "hanging" of the forest in children;

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

Skushina Vera Nikolaevna

Therapist, Education: Northern Medical University. Work experience of 10 years.

Posted articles

In modern medicine, there is an opportunity to diagnose and cure most of the known diseases. For this, new drugs are constantly being created and examination techniques are being developed. But, as before, some diseases are well treatment, if the diagnosis was carried out on early stages.

The inflammation of the brain shells is a serious illness with serious consequences, in time the observed meningeal symptoms give a doctor the opportunity to begin treatment in the early stages of the disease.

The importance of the correct diagnosis

Meningkeal signs in neurology are important for the correct diagnosis. Their manifestation most often indicates inflammation in brain shears. Meningkeal signs may indicate such severe diseases as:

• meningitis;
• purulent heavy otitis;
• sepsis with different genesis;
• inlet hemorrhage;
• abscess soft tissues in the cervical department;
• CMT and injuries in the back area;
• disintegration of the tumor.

Each qualified physician should be able to recognize these signs to correctly diagnose the disease and assign adequate treatment. Any symptoms indicating the inflammatory process in brain shears serves as a reason for the patient's full examination.

Classification of meningeal symptoms

In medical practice, numerous symptoms indicating the inflammatory process developing in brain shells are described in detail. The most significant symptoms received their name according to the names of researchers, they allocate:

• Symptom of Kerniga.

The symptom of Kerniga is the meningeal (the most bright) symptom, is considered the most famous and verifiable. At the end of the nineteenth century, the infectiousist Kernig described the sign. Check are carried out as follows:

1. The adult patient is placed on the straight surface on the back.
2. The doctor bends my sick leg first in the hip, then in the knee.
3. The doctor then tries to straighten his knee leg.

A positive feature pointing to the meningeal (inflammatory) syndrome is considered to be difficulties with the extension of the limb (inability). This is due to the reflex hypertonus muscles arising from inflammation in the shells.

A false-positive result is often fixed in the elderly, having a diagnosis of Parkinson's disease. A negative result may mean that the patient has developed a hemiparesis on the side of the pares. It's all about the weak muscles of the patient.

• Symptom of Brudzinsky.

A description of the signs pointing to meningitis, the Polish doctor Brudzinsky amounted to at the very beginning of the twentieth century, since then they are actively used in diagnosis.

Verification of the top feature is carried out like this: the doctor is trying to attract chin to the thoracic patient from the position lying on the back. Incultuous flexion of the legs (attempt to pull the finiteness to the stomach) indicates the inflammatory process in the brain shell.

Checking the average feature is carried out as follows: the doctor slightly presses the patient's pubic area, the involuntary bending of the legs in the hip and knee joints indicates inflammation.

Checking the lunch is carried out like this: the doctor presses the patient's skil. Incultuous bending at the same time, hands in the elbow means the development of the inflammatory process in the brain.

• Headache.

One of the signs of meningitis is the headache, which becomes stronger when presing the patient on the eyeballs. The pressure on the outer hearing pass (Mendel symptom) also leads to increased pain. A painful grimace appears on the patient's face, the facial muscles begin to reflexively shrink. Such signs are reason to assume that the patient began inflammation of the brain shells.

Bokisma symptom of Bekhtereva is used to diagnose. The test is carried out like this: the doctor tapping the patient on the cheekbone, the positive result is expressed by a sharp increase in the headache, the tension of the facial muscles, the appearance of pain grimaces from the press. Sudden intense headache (feeling like a blow to the head) can mean spontaneous hemorrhage, while the patient develops focal neurological deficit.

• Reflex Gordon.

The pathological reflex of the lower limbs described by Gordon allows diagnosing the irritation of the brain shells. It is carried out as follows: the doctor squeezes the icy muscle, with a positive result, all the fingers on the leg are moved like a fan.

It is worth remembering that the presence of the Gordon reflex in a small child does not mean the development of the inflammatory process, but is the norm.

• Hyperesthesia.

Skin hyperesthesia, pronounced cefalgia, intense headache, vomiting, nausea, light-friendly, may indicate the irritation of the cerebral shells, even in the absence of other bright signs of the disease. Such symptoms often manifests itself on initial stage Diseases.

• Others.

The Babinsky researcher described the following sign characteristic of inflammatory processes in brain shells: the impact of the acute object on the patient's foot leads to outwarding and straightening the thumb.

The rigidity of the cervical and occipital muscles is another feature testifying to the inflammatory process in the brain. The patient is impossible to hinder the head and touch the chin of the breast due to strong voltage in the muscles of the neck.

• Rare species.

Modern medicine describes rare types of meningeal symptoms, which can accompany the irritation of the brain shells.

The patient opens his mouth, trying to get the chin to the chest (Reflex Levinson).

Patients are expanding pupils at the slightest tactile impact (PERRR REFLEX).

Meningheal symptoms in children

Brain shell inflammation is often diagnosed with newborns and children younger age. The disease develops instantly, threatens with severe complications.

The presence of the inflammatory process in the brain shells requires the immediate hospitalization of the baby, the delay can lead to a fatal outcome. In pediatrics, it is known that the diagnostics of the state is often hampered. The first signs of irritation of cerebral shells in kids are extremely similar to the development of viral disease.

When appearance the following signs Parents should urgently apply for medical care:

1. The kid has a high temperature that cannot be knocked down.
2. The child dries the mucous membrane of the mouth.
3. The infant has a sinusiness in the nasolabial triangle.
4. The kid has a pulse, the skin pale, a shortness of breath appeared.
5. The child began vomiting.
6. The baby has a painful grimace when pressed on the eyeballs, top lip, forehead.

For children, common meningeal signs are characterized, there are also special features inherent in infant age.

Muscle's rigidity, Reflex Kerniga or Burutsinsky manifests itself with the disease in young children. For babies, the following diagnostic method is used (symptom of the forest): The baby is kept for armpits, keeping his head, his knees reflexively begin to rise to the chest.

• With the child begins abundant vomiting, severe headaches, general weakness.
• If the infection occurred with airborne droplets, it appears in the throat, runny nose.
• The infection that fell through water or food causes the baby pain in the abdomen, diarrhea.

But intolerable headaches, afraid of bright light and loud sounds, cramps, muscle tensions, ripple springs, intolerance to tactile sensations indicate inflammatory processes In the brain shells and require immediate hospitalization.

With irritation of the brain shells and spinal cords, meningeal symptoms occur, observed in various diseases of the head and spinal cord:

Meningheal Pose "Pose of Ruge Curck" - The position of the patient with the trapped head, dispelled torso and tightened to the belly legs.

Cerniga sympathetic - a patient lying on the back, bend the leg in the hip and knee joints at a right angle, and then it is inflicted in the knee joint. The symptom is considered positive if the leg is not possible to break in the knee joint due to the sharp resistance of the bending of the lower leg and pain reaction.

Rigidity of the occipital muscles - in the position of the patient on the back by active or passive bending of the head to the chest. In the presence of muscle rigidity, the nape of the patient's chin does not reach the chest and the pain occurs.

The symptom of Brudzinsky Upper - Determination of muscle rigidity The nape causes involuntary bending of legs in hip and knee joints.

Symptom of Brudzinsky Middle - When pressing on the pubic area, bending legs in the knee and hip joints is observed.

Symptom of Brudzinsky Nizhny - With the passive bending of one leg in the hip joint and extension of it in the knee joint, an involuntary high-purity of the other legs occurs.

Symptom of Ledsa (hanging) - Take a baby under the mouse and raise, while his legs involuntarily pull up to the stomach.

Symptom Bekhtereva (Zhilogo) - When percussion, a shiny muscles and involuntary pain grimace arises with a perculse arge.

Symptom Guiena - squeezing the four-headed muscles of the thigh on the one hand leads to involuntary bending of another leg in the knee and hip joints.

22. The most commonly detected symptoms during brucellosis

Bekhtereva - lumbosacious radiculitis. Pain in the patent yam when straightening the leg bent in the knee joint.

Or - a sign of the defeat of a sacral-iliac articulation. If the patient lying on his stomach, bend the leg in the knee joint so that the shin comes into contact with the hips, the pelvis is lifted and removes from the table.

Lag - a sign of the pathology of a sacratling and iliac articulation. Pressing on the heel, elongated, reserved and rotated in the foot of the foot, causes pain in a patient.

Larreya - Pain in sedal Nerve, the sacrum, during the transition from the position lying to the sitting position.

Kushhelevsky - a) Pressure palms on the scallops of the iliac bones in the position of the patient on the side causes a sharp pain in the field of both sacrats and iliac artists. B) Tasching the pelvis with the fingers of both hands fixed on the scallops of both iliac bones significantly increases the intensity of pain in the articulations.

Makarova is a sign of sacroileite. The appearance of pain when the hammer in the field of sacratling joint artists.

C-M "Landing" Minor - when trying to sit in bed with elongated legs, while trying to bend the torso, there is a reflex flexion in the knee joint of one or both legs.

Opokina (C-M "Ripe Watermelon", C - M "Symphizitis") - a) squeezing the pushing the pushing movements, can be heard using a phonedoscope crunch in the region of the Lonatic joint. B) lifting legs bent in her knee in the position of the patient on the stomach, causes a sharp pain in a sacratsoy-iliac joint. When trying to turn on the side, the patient carefully fixes the lumbosacral spine and the pelvis; Relieving in the head back of the bed, the patient turns to all the body due to the strong pain in the Ileoshast articulation, movements are limited in the hip joint.

S - M Otaraeva I. A., Otarayeva B. I. - proposed for the purpose differential diagnosis: Easy load on the straightened lower limb from the affected side by tearing the hammer on the heel bone. In the case of sacroileite, the pain is intensified in the field of articulation. This symptom is positive in all patients with brucellular sacroileite in a subacter and chronic periods and is negative with lumbar radiculitis and other lesions of the peripheral nervous system.

Erixena is a differential-diagnostic sign of the pathology of sacratling and ileum and a hip joint, polyartronaceyalgia. If the patient is quickly comprehended by both iliac bones, then the appearance of pain indicates the presence of pathology in the field of sacratling and ileum.

23. Interpretation of R-shots in patients with lesion of the musculoskeletal system in infectious diseases (brucellosis).

24. Preparation of smear and thick blood drops in malaria

Skin glasses on which preparations prepare must be well washed and degreased. The skin of the finger is wiped with alcohol and pierce. The first speaking drop of blood wipe the dry cotton, then the finger turn the punch down and touches the tin glass to the second drop. The smear should not reach to the end, nor to the edges of the subject glass. Therefore, a drop of blood should be a diameter of no more than 2 - 3 mm. The subject ground glass, which makes the smear, there must be glass to be applied to the smear. In order to prepare the smear, ground glass put in front of a blood drop at an angle of 45 ° and promoted forward to contact with it. When blood is evenly distributed between both glasses, smear makes a quick movement.

Prepared thick drops are dried at room temperature at least 2 - 3 hours without any additional heating to avoid fixation of blood. After drying, the drops are poured onto the paint of Romanovsky - gimsi (diluted in the ratio of 2 drops of paint per 1 ml of distilled water). The duration of the color on average is 30 - 45 minutes. The painted drop is carefully rinsed with tap water (a strong jet can wash off a drop) and dried in a vertical position.

The smears are fixed by placing them for 3 minutes in methyl or 10 minutes at 96% ethyl alt. Fixed preparations are dried in air. Then the drugs are placed in a special container and paint azur-eosine dye along Romanovsky - Gymzem for 20 to 30 minutes. After this period, the container is substituted under a weak jet of water and washed. The drop on the smear is painted in the same way as a thick drop.

Wash preparations are dried and examined under the microscope. In infected erythrocytes, plasmodia of malaria with blue cytoplasm and bright red core are visible. Finding plasmodiodes of malaria in the blood of a patient is an indisputable proof of the disease.

25. The order of manifolding and removing the protective (anticipate) costume

1) pajamas (koyabizon).

2) Socks, boots.

3) big brazer (hood).

4) Antician Bathrobe.

5) Valito-gauze mask.

7) Gloves

The phonenoscope is put in front of a shop. Ribbons on the gate of a bathrobe, as well as the belt are tied on the front on the left side, be sure to loop; Then the ribbons are tied on the sleeves. The mask is put on the face so that the mouth and nose were closed, so the top edge of the mask should be at the level of the lower side of the orbit, and the bottom - under the chin. Mask ribbons are tied loop by the type of prassevoid bandage. Owing mask, on the sides of the wings of the nose laid cotton swabs so that the air does not pass under the mask. Glass glasses are rubbed dry soap to warn their fogging. Towel lay the belt.

Order of shooting

After completing the work, the costume is removed slowly, in a strictly installed manner, immersing your hands in gloves into a disinfecting solution after removing each part of the costume. The boots wipe down from top to date with separate tampons, moistened with disinfectant solution. Take out a towel. Remove glasses moving up and back. Without touching open areas of the skin, they are exempt from the phonedoscope. Glasses and phonedoscope are placed in a jar with 70% alcohol. Remove the mask, holding the risks, and, without letting them out of the hands, make a mask with the outside side inside. Then, lowering the upper edges of the gloves, remove the bathrobe, simultaneously turning it out with the outside. Unleash and remove the ghost, then gloves and, finally, pajamas. Freed from costume, hands handle 70% alcohol and carefully wash with soap.

After each application, an anticipated costume is disinfected.