From Big Medical Encyclopedia

MENINGISM (meningismus; grech, meninx, meningos a meninx) — the clinical implication of irritation of a meninx which is characterized by existence of meningeal symptoms (a stiff neck, Kernig's signs, Brudzinsky, etc.) without inflammatory changes of cerebrospinal liquid. The m is in most cases connected with increase in intracranial pressure owing to hyperproduction or disturbance of a resorption of cerebrospinal liquid (hydrocephaly) or wet brain and its covers. It can be observed at many inf. the diseases proceeding with intoxication — pneumonia, acute dysentery, a salmonellosis, belly and sypny typhus, quinsy, flu, an infectious mononucleosis, etc., at tumors of a brain and the shell processes in a back cranial pole, at craniocereberal injuries, acute disorders of cerebral circulation.

M.'s phenomena at inf. diseases meet at children more often. Usually they arise in the acute period of a disease and remain within 2 — 4 days, quickly disappearing at involution of a basic disease.

At tumors of a brainstem and back cranial pole or at adhesive shell processes in a back cranial pole of M. develops owing to the acute intracranial hypertensia resulting from disturbance of outflow. In rare instances in cerebrospinal liquid the small pleocytosis of the lymphocytic or mixed character can appear.

Wet brain and its covers at a craniocereberal injury also usually proceeds with M.'s symptoms, to-ry can develop even when the injury is not followed the subshell by hemorrhage. More often M. develops directly after an injury, but sometimes at an injury of easy or average degree, through a nek-swarm time after it; in such cases Meningeal symptoms are caused by the developing hyper productive hydrocephaly.

The wet brain and its covers which is followed by M.'s symptoms can arise at insolation, overheating, an idiopathic hypertensia, uraemia, a poisoning with carbon monoxide.

Diagnosis The m is based on existence of meningeal symptoms, to-rye are, as a rule, expressed poorly and quickly disappear. For differential diagnosis with meningitis (see) major importance has a research cerebrospinal liquid (see) and nature of disease. Cerebrospinal liquid at M. usually follows under supertension, but has normal structure. Small increase in protein content due to increase in amount of albumine, or, on the contrary, decrease in number of cells and protein (cerebrospinal liquid is only sometimes noted at hydrocephaly).

In an initial stage of meningitis, especially tubercular and meningococcal when the disease-producing factor already got into a meninx, inflammatory changes in cerebrospinal liquid still can be absent. M. observed in these cases, apparently, is caused by excess products of cerebrospinal liquid and limited hypostasis of a meninx. At the repeated research of cerebrospinal liquid conducted in a day the pleocytosis and moderately increased protein content can sometimes be found.

Treatment comes down to decrease intracranial pressure (see) and to elimination of the reasons causing M. For the purpose of decrease in intracranial pressure appoint diuretics, from to-rykh more preferably Diacarbum oppressing function of vascular textures. Intramusculary enter 25% solution of magnesium sulfate.

At M. at patients inf. diseases the positive effect gives spinal puncture (see); at hydrocephaly effect of the specified therapy short-term. At suspicion of a tumor of a brainstem and a back cranial pole the lumbar puncture is carried out only in the conditions of a neurosurgical hospital.

Bibliography: Mautner G. Meningitis and a meningism, the lane with it., M., 1927; Pokrovsk V. I., Favorov L. A., and Kostyukova N. N. Meningococcal infection, page 172, M., 1976; X e of hl and N of River. Differential diagnosis of internal diseases, the lane with it., page 130, 153, M., 1965; Shamburov D. A. Cerebrospinal fluid, M., 1954.

V. I. Pokrovsky.