- Infectious Causes: Virus (Enterovirus, Arbovirus, HIV, HSV 1 - 2), bacteria (Neisseria meningitidis which represents 90% of cases of meningococcal disease Worldwide, Streptococcus pneumoniae and Haemophilus influenzae type B, fungi (Candida albicans, Aspergillus fumigatus, Cryptococcus neoformans, Mucor), protozoa and helminths among others.
- Inflammatory Causes: due to systemic diseases, drugs, surgery, tumors or cysts.
Bacterial meningoencephalitis also called pyogenic or suppurative purulent infection is an acute, localized within the subarachnoid space. It is accompanied by an inflammatory reaction that can produce a variety of demonstrations.
meningoencephalitis General has a triad is: Headache, fever and neck stiffness.
When this triad is associated with somnolence, stupor or seizure activity, is suggestive of bacterial meningitis.
For meningococcal meningitis, you can see the inspection the presence of hemorrhagic spots on the skin.
In order to correlate the pathophysiology of clinical disease that occurs, the picture of meningoencephalitis is classified into 4 groups of clinical manifestations.
1) Table infectious It is manifested by fever, hypothermia, anorexia and general condition of
2) intracranial hypertension, as evidenced by vomiting, headache, irritability, bulging fontanelle, and changes in alertness
3) meningeal irritation: manifested by neck stiffness and Kernig's signs and Brudzinsky positive.
4) neuronal damage: by altered state of consciousness, seizures and in some patients by targeting data (the acute management of the patient should be oriented around this point)
"But I reached the microorganism the CNS?
The organism can reach the Central Nervous System by 3 pathways:
- hematogenous from a distant source of infection, from which bacteremia occurs, and then enters the cerebrospinal fluid after its accession to the capillaries of the blood brain barrier, mainly in the choroid plexus of the cerebral ventricles.
- You can also spread by CONTIGUITY parameningeal or from a point either intravenous retrograde, as in the case of acute otitis media or through a fistula, cranial and spinal anatomy.
- The infection can be DIRECT like after neurosurgical intervention or after traumatic brain injury. Once they reach the cerebrospinal fluid, bacteria multiply rapidly (due to the absence of effective immune responses at this level) and induce the activation of cytokines that trigger an inflammatory process, which causes increased permeability of the barrier blood-brain influx of polymorphonuclear leukocytes and humoral components.
As a result of all this occurs: ischemia, cerebral edema, increased intracranial pressure and neuronal injury.
The Diagnosis is made by:
Clinical Anamnesis
lumbar puncture (Table)
Blood cultures Other laboratory examinations
TAC
If petechial skin lesions: biopsy
Acute severe cerebral edema, disseminated intravascular coagulation Shock, thrombo-haemorrhagic syndromes Brain Injury Seizure subacute> 72 h
Complications
The critical event in the pathogenesis of meningoencefaltis inflammatory reaction is triggered in order to eliminate the pathogen.
For presentation time Complication
<72>
inappropriate ADH secretion
Empyema, subdural hygroma
ependymitis
ventricular thrombo-haemorrhagic hydrocephalus
Phenomena
Delayed> 1 week hearing loss
motor deficit
language disorders behavioral disorders Mental retardation
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