A Simple Guide to Meningitis

A Simple Guide to Meningitis
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What is Meningitis?
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Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.

What are the causes of Meningitis?
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The causes of Meningitis may be divided into:

Infections:
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1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal meningitis can cause outbreaks(spread easily).

E.coli, Group B streptococus and Pseudomonas infection are common in neonates.

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children

Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.

Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.

3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis

Non-infectious:
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Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:

1.cancers,

2.systemic lupus erythematosus

3.drugs.

4.head injury

5.post neurosurgical procedures


What are Signs and symptoms of Meningitis?
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The triad of symptoms which often defines meningitis are:

1.Severe headache

2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.

3.vomiting

Other symptoms are:

4.high fever

5.mental confusion.

6.Malaise

7.photo-phobia (inability to tolerate bright light),

8.phono-phobia (inability to tolerate loud noises),

9.irritability especially in small children

10.seizures .

11.swelling of the fontanelle may be present in infants

12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms

13.ulcers of the mouth (present in hand,mouth and foot disease).

How is the diagnosis of Meningitis made?
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1.Classical symptoms and signs as above especially neck rigidity

2.blood tests (complete blood count, ESR and blood culture)

3.X-rays of chest and brain

4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)

A pressure of over 180 mm suggests bacterial meningitis.

5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis

6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Meningitis?
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1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Meningitis?
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1.Hospitalization should be immediate as meningitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of Meningitis?
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This depends on the severity and type of infection.

Viral infections except for enterovirus EV7 usually recover quickly.

Bacterial infections such as meningococcus and pneumococcus are more dangerous.

What are the Preventive measures taken for Meningitis?
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Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.

Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.

Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.

Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis

A Simple Guide to Cerebral Palsy

A Simple Guide to Cerebral Palsy
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What is Cerebral Palsy?
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Cerebral palsy refers to a group of disorders characterised by loss of motor functions or any other nerve functions that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don't worsen over time.
Even though cerebral palsy affects muscle movement, it isn't caused by problems in the muscles or nerves. These disorders are caused by brain damage that occurs during foetal development or near the time of birth.

What are the causes of Cerebral Palsy?
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The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later.
Cerebral Palsy is mainly caused by brain damage that occurs during foetal development.
A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life:
1. brain infections such as bacterial meningitis or viral encephalitis
2. head injury from a motor vehicle accident, a fall, or child abuse.

It is not an inherited disease.

What are the Symptoms of Cerebral Palsy?
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The early signs of cerebral palsy usually appear before a child reaches 3 years of age. Babies with Cerebral Palsy are usually slow to reach developmental milestones.
Abilities like learning to roll over, sit, crawl, smile or walk are not well developed.

The motor abilities will often seem unusual and strange.
The most common are:
1.lack of muscle coordination when performing voluntary movements (ataxia);
2.stiff or tight muscles and exaggerated reflexes (spasticity);
3.walking with one foot or leg dragging;
4.walking on the toes,
5.crouched gait, or a "scissored" gait:
6.muscle tone that is either too stiff or too floppy.

The symptoms of Cerebral Palsy vary from just mild clumsiness to extensive uncontrolled muscle spasticity.
Many with cerebral palsy have other disabilities :
1.seizures,
2.an inability to see, hear, speak or learn as others do,
3.psychological or behavioural problems.

Not everyone with Cerebral Palsy is retarded. Some are of average intelligence.
While some people with Cerebral Palsy have learning disabilities many others do not.

What are the Types of Cerebral Palsy?
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There are four types of Cerebral Palsy:
1.Spastic Cerebral Palsy, the most common type, is a disorder in which certain muscles are stiff and weak.
2.Athetoid (dyskinetic, hypotonic, dystonia) Cerebral Palsy where involuntary movements are present.
3.Ataxic Cerebral Palsy occurs when the Cerebellum has been damaged, thus causing lack of coordination and jerky movements. This form of Cerebral Palsy have staggered or fragmented movements often involving tremors or exaggerated posturing (athetosis) and bizarre twisting motions.
4.Mixed Cerebral Palsy is when two or more types of cerebral palsy are present in the same person.

What is the Treatment of Cerebral Palsy?
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Cerebral Palsy is a lifelong condition that cannot be cured.
The treatment is aimed at maintaining or improving the quality of life, providing the sufferer with tools to enjoy a near-normal life.

There are basically three types of treatment for Cerebral Palsy:
1.Surgery can be used to correct muscle contractures - removal of tight contractures that inhibits proper movement of the limbs.
2.Drugs such as clonazepam, baclofen and dantrolene are sometimes used to control muscle spasticity. Anticholinergic medications can help to control abnormal movements.
Alcohol or botulinum toxin type A (Botox) injections into muscle may be used to reduce spasticity for a short time so health care providers can work to lengthen a muscle.
3.Adjunctive therapies include
a.Physiotherapy, the most common treatment for cerebral palsy, consists of special exercises designed to increase and improve the range of movement and strength of the muscle groups, is aimed at strengthening and stretching muscles and preventing spasticity as well as increasing muscle control.
b.Occupational therapy is designed to help the child develop the fine motor skills needed to function day-to-day at home and school.
c.Speech therapy will also help the child develop communication skills.

What is the prognosis of Cerebral Palsy?
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Cerebral palsy doesn't always cause profound disabilities.
A child with severe cerebral palsy might be unable to walk and need extensive, lifelong care.
Another with mild cerebral palsy might be only slightly awkward and require no special assistance.

Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.