Clinical presentation in adults and children with closed fontanelles
The manifestations of the pathology are directly related to increased intracranial pressure. Patients complain of intense headache, nausea, and characteristic projectile vomiting, which often occurs in the morning on an empty stomach.
Key signs include signs of meningeal irritation:
- Nuchal rigidity
- Head retraction and opisthotonos
- Photophobia
As the process progresses, fatigue, cognitive impairment, gait instability, cranial nerve palsies (including the abducens nerve), Parinaud syndrome, papilledema, and dangerous alterations of consciousness develop.
Methods for examining meningeal signs
To objectively assess the patient's condition, the physician performs special physical tests:
- Nuchal rigidity: with the patient in the supine position, the physician passively flexes their head, attempting to touch the chest with the chin. The sign is positive if the movement is impossible due to firm resistance from the neck muscles.
- Kernig's sign: the leg is flexed at the hip and knee joints at a right angle, after which an attempt is made to straighten it at the knee. Full extension is blocked by reflex muscle tension.
- Brudzinski's signs: upper (flexion of the legs when tilting the head), middle (flexion of the legs when pressing on the pubic symphysis), and lower (flexion of the contralateral leg when testing Kernig's sign).
- Bechterew's sign: percussion on the zygomatic bone causes increased headache and a pain grimace.
Features in infants and diagnostics
In infants, the clinical picture is complemented by specific signs:
- «Setting sun» phenomenon (upward gaze palsy).
- General developmental delay.
Diagnosis of hydrocephalus and associated complications includes prenatal ultrasound, as well as postnatal head circumference monitoring. Instrumental examination of newborns is mandatorily supplemented by brain CT and MRI to rule out subdural hematomas, hygromas, and to search for treatable causes. In adults, CT and MRI also remain the methods of choice, allowing visualization of ventricular enlargement. If the cause cannot be eliminated, surgical cerebrospinal fluid shunting is used.
«Occiput to chest, bend the leg — expect Kernig and Brudzinski!» Helps to quickly recall basic meningeal signs.
Class and exam questions
What are the main symptoms characteristic of meningitis in adults?
Manifestations are caused by intracranial hypertension: severe headache, morning projectile vomiting, photophobia, nuchal rigidity, and a positive Kernig's sign.
Why is ultrasound alone insufficient when diagnosing hydrocephalus in children?
Ultrasound alone is insufficient, as brain CT and MRI are mandatory to identify treatable causes and rule out subdural hematomas, hygromas, and familial macrocephaly.
How is the upper Brudzinski sign tested?
It is tested simultaneously with nuchal rigidity: passive forward tilting of the patient's head results in involuntary flexion of the legs at the hip and knee joints.
What else to study on this topic
- Mumps virus and its neurological complications
- Salmonellosis in children: generalized forms and secondary purulent foci
- HHV-7 infection and cases of specific meningoencephalitis
- Intracranial hypertension and its pathogenetic mechanisms
- Surgical cerebrospinal fluid shunting
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