Meningitis
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Definition/Description[edit | edit source]
Meningitis is an infectious disease of the central nervous system that causes inflammation of the meningeal membranes. All three meningies may become involved, dura matter, arachnoid, and pia matter.[1][2] The pia matter and arachnoid layers become inflamed and opaque. The first two layers of the cortex and the spinal cord become inflamed as well.[1] As a result of the inflammation many complications may occur. There is an increased risk of infarctions and cortical veins may develop thrombosis. In addition, blockage of the flow of CSF may occur secondary to scar tissue. This blockage is most common at the base of the brain. CSF blockage may result in subarachnoid cysts or hydrocephaly resulting in a headache, considered a cardinal sign.[1] The disease may present as acute (over a period of hours or days), subacute (more than two weeks), or chronic (more than one month).[2]
Aseptic and Bacterial meningitis are the most common forms of acute meningitis. Aseptic meningitis is usually a result of fungi, viruses, parasites, bacteria, or in some cases a noninfectious inflammation. This form of meningitis is usually self-limited. Bacterial meningitis is a much more serious illness and if goes untreated is fatal. Progression is very rapid and is distinguished by purulent CSF.[2]
Prevalence[edit | edit source]
The prevalence of meningitis has greatly decreased over the last fifteen years due to the development of vaccines.[1] The second most common bacteria that causes acute bacterial meningitis, meningocicci, is present in the nasopharynx of approximately 5% of the population. Close contact or respiratory droplets may spread the bacteria. Of the population that has the bacteria, only a small fraction develops meningitis and the most prevalent age range is from birth to one year.[2] As individuals move through the late adolescence development stage, they experience a second period of increased vulnerability. In adulthood, bacterial meningitis usually is limited to individuals who have conditions that inhibit the immune system.[1] Bacterial meningitis is usually associated with This form of meningitis appears more frequently in populations that are in close living quarters such as college dormitories, military barracks, and boarding schools.[2]
Characteristics/Clinical Presentation[edit | edit source]
Headache, fever, and rigidity of the neck are the most common symptoms that present with the onset of meningitis.[1][2] Pain in the posterior thigh or lumbar region may also be noted.[1] Meningitis causes inflammation of the meningeal membranes, as a result nerve roots may endure tension as they pass through the inflamed membranes. Passive ROM of the neck into flexion will become painful and limited. Extension and rotation may be painful as well, but to the extent of in the direction of flexion. In some cases passive neck flexion may produce flexion of the hips or knee, this is known as Brudzinki’s sign and is usually only seen in the most severe cases. Another sign that is usually seen in the most severe cases is the Kernig’s sign, which is defined as passive extension of the knee while the hip is flexed that produces restriction.[2]
In cases when meningitis is not treated immediately (especially bacterial meningitis), the parenchyma within the brain may be involved. As a result individuals may present with lethargy, vomiting, seizures, papilledema, confusion, coma, focal deficits, and cranial nerve palsies.[1][2]
(PIC of Brudzinki’s sign and kernig’s)
Associated Co-morbidities[edit | edit source]
Predisposing conditions of meningitis include sinusitis, mastioditis, and otitis. These conditions may require specialized treatment.[1] Damage or removal of the spleen increases the risk of pneumococcal disease which may lead to acute bacterial meningitis. Conditions in which an individuals immune system may become compromised increase the risk and severity of meningitis, such as HIV.[1][2]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1. Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis, Missouri: Saunders Elsevier, 2009.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2. Beers MH, et. al. eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006
