MENINGEAL SYNDROME: DIAGNOSTIC ALGORITHM, TREATMENT TACTICS

  2. 2023
  3. MENINGEAL SYNDROME: DIAGNOSTIC ALGORITHM, TREATMENT TACTICS

Zdor O. I., Iziumska O. M., Lymarenko N. P., Poltorapavlov V. A., Bodnar V. A., Artemyeva E. V., Koval T. I.

MENINGEAL SYNDROME: DIAGNOSTIC ALGORITHM, TREATMENT TACTICS

Show/Download

About the author:

Zdor O. I., Iziumska O. M., Lymarenko N. P., Poltorapavlov V. A., Bodnar V. A., Artemyeva E. V., Koval T. I.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

The article analyzes modern data on diagnosing and treating meningeal syndrome and proposes a diagnostic search algorithm and treatment tactics for patient management. General statistical information on the prevalence of bacterial meningitis, one of the causes of the development of meningeal syndrome, is provided. A detailed definition of meningeal syndrome and its differences from meningism are described. The article contains classifications of meningeal syndrome according to various criteria: etiological factors, pathogenesis, severity of the course and localization of the pathological process. The stages of diagnostic search and examination of patients are described in detail using laboratory and instrumental methods of research, which are schematically shown in the form of an algorithm. Attention is paid to possible diagnostic mistakes during the examination of the patient at the pre-hospital stage. The changes in the cerebrospinal fluid depending on the pathomorphology of the inflammatory process are described, and the comparative characteristics of its composition in normal conditions and during the development of serous and purulent inflammation are given. The primary pathogens that can cause serous or purulent meningitis with corresponding changes in the cerebrospinal fluid in the clinic of infectious diseases are characterized. A separate section is devoted to the tactics of managing patients in the clinic of infectious diseases and proposed additional methods of examination depending on the clinical situation. Also described are non-infectious illnesses that can occur with the meningeal syndrome, such as subarachnoid haemorrhages, focal lesions of the central nervous system (abscesses, tumours), metastases of tumours of other localization, systemic connective tissue diseases, vasculitis, etc. The article also provides examples of therapy depending on nosology in the clinic of infectious diseases and suggests monitoring of treatment effectiveness.

Tags:

algorithm, diagnosis, meningeal syndrome, treatment

Bibliography:

  1. GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 May;18(5):459-480. DOI: 10.1016/S1474-4422(18)30499-X.
  2. Chaudhuri A, Martinez-Martin P, Kennedy PG, Seaton AR, Portegies P, Bojar M, et al. EFNS guideline on the management of communityacquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul;15(7):649-59. DOI: 10.1111/j.1468-1331.2008.02193.x.
  3. Syrogiannopoulos GA, Michoula AN, Grivea IN. Global epidemiology of vaccine-preventable bacterial meningitis. Pediatr Infect Dis J. 2022 Dec 1;41(12):e525-e529. DOI: 10.1097/INF.0000000000003629.
  4. Shkrobot SI, Saliy ZV, Budarna OY, Sokhor NR, Saliy MI. Topichna diagnostyka patologii nervovoi systemy. Algorytm diagnostychnogo poshuku. Ternopil: TDMU; 2019. 156 s. [in Ukrainian].
  5. Riabokon OV, Onishchenko TE, Ushenina NS, Furyk OO. Infekcijni khvoroby: navch. posib. dlia studentiv 4-go kursu medychnogo facultetu specialnosty 221 «Stomatologiya» riven pidgotovky magistr-stomatolog. Zaporiggia: ZDMU; 2019. 182 s. [in Ukrainian].
  6. Svintsitskyy AS, Gaevskyy P. Vnutrishni khvoroby. Pidruchnik, zasnovaniy na principakh dokazovoi medycyny 2018/19. Krakiv: Praktyczna medycyna; 2018. 1632 s. [in Ukrainian].
  7. Yekani M, Memar MY. Immunologic biomarkers for bacterial meningitis. Clinica Chimica Acta. 2023 Jul 5;548:117470. DOI: 10.1016/j.cca. 2023.117470.
  8. McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. Lancet. 2016 Dec 17;388(10063):3036- 3047. DOI: 10.1016/S0140-6736(16)30654-7.
  9. Kalmi G, Javeri F, Vanjak A, Kirren Q, Green A, Jarrin I, et al. Drug-induced meningitis: A review of the literature and comparison with an historical cohort of viral meningitis cases. Therapies. 2020;75(6):605-615. DOI: 10.1016/j.therap.2020.03.001.
  10. Melhuish A, McGill F. Viral meningitis and encephalitis. Medicine. 2021 Sep 25;49(11):675-680. DOI: 10.1016/j.mpmed.2021.08.004.
  11. Giacomelli A, Antinori S. Fungal Meningitis. Encyclopedia of Infection and Immunity. 2022;3:323-338. DOI: 10.1016/B978-0-12-818731- 9.00125-7.
  12. Pekova L, Parushevaa P, Mitev M, Dochev I., Naydenov C. A rare case of an HIV-seronegative patient with toxoplasma gondii meningoencephalitis. ID Cases. 2021;26:e01271. DOI: 10.1016/j.idcr.2021.e01271.
  13. Riabokon OV, Ushenina NS, Furyk OO, Zadyraka DA. Meningealniy syndrom v klinicy infectsiynih hvorob. Nabryak-nabuhannya golovnogo mozku (nevidkladna dopomoga): navch. posib. dlya studentiv 6 kursu medichnih fakultetiv. Vid. 2, dopov. ta pererob. Zaporiggia: ZDMU; 2021. 105 s. [in Ukranian].
  14. Aksamit AJ. Chronic meningitis. New England Journal of Medicine. 2021 Sep 2;385(10):930-936. DOI: 10.1056/NEJMra2032996.
  15. Thakur KT, Wilson MR. Chronic Meningitis. Continuum (Minneap Minn). 2018 Oct; 24(5):1298-1326. DOI: 10.1212/CON.0000000000000664.
  16. Baldwin K, Whiting C. Chronic meningitis: simplifying a diagnostic challenge. Current Neurology and Neuroscience Reports. 2016 Feb;16(3):30. DOI: 10.1007/s11910-016-0630-0.
  17. Yevtushenko VV, Kramarev SA, Kaminska TM, Lytvynenko NH. A case of benign recurrent aseptic Mollaret’s meningitis caused by herpes simplex virus 1/2 in a 9-year-old child. Actual Infectology. 2018 Jun;6(2):103-105. DOI: 10.22141/2312-413x.6.2.2018.131099.
  18. Kolho E, Atula S. Nastanova 00773. Meningit u doroslih [Internet]. Available from: https://guidelines.moz.gov.ua/documents/3556.
  19. Kozyolkin OD, Medvedkova SO, Lisova OO, Laponov OM. Infectsiyni zahvoruvannya nervovoi systemi (meningity, entsefality, mijelity, nevrologichni projavi VICH-infectsii): navch. posib. dlya likariv-interniv specialnosti «Nevrologija», «Zagalna (simeyna) practika» likarivnevrologiv, simeynih likariv. Zaporiggia: ZDMU; 2023. 154 s. [in Ukrainian].
  20. Lytvynenko NV, Sanyk OV. Algorytm zasvojennya practichnih navichok ta vmin v nevrologii: navch. posib. Dlya likariv-interniv za specialnistju «Nevrologija». Poltava: UMSA; 2018. 159 s. [in Ukrainian].
  21. Al-Qahtani SM, Shati AA, Alqahtani YA, Ali AS. Etiology, clinical phenotypes, epidemiological correlates, laboratory biomarkers and diagnostic challenges of pediatric viral meningitis: descriptive review. Frontiers in Pediatrics. 2022 Jun 16;10:923125. DOI: 10.3389/fped. 2022.923125.
  22. Boedeker D, Shaddeau A. Herpes simplex meningitis presenting as headache in pregnancy: A case report. Women’s Health. 2022 Oct;36:e00451. DOI: 10.1016/j.crwh.2022.e00451.
  23. Lenfant T, L’Honneur A-S, Ranque B, Pilmis B, Charlier C, Zuber M, et al. Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid. Brain and Behavior. 2022 Feb;12(2):e2455. DOI: 10.1002/brb3.2455.
  24. Alvarez JC, Alvarez J, Tinoco SJ, Mellado P, Miranda H, Ferrés M. Varicella-Zoster virus meningitis and encephalitis: an understated cause of central nervous system infections. Cureus. 2020 Nov 20;12(11):e11583. DOI: 10.7759/cureus.11583.
  25. Vidal LR, Monteiro de Almeida S, Cavalli BM, Gutierrez Dieckmann T, Raboni SM, Salvador GLO, et al. Human adenovirus meningoencephalitis: a 3-years’ overview. Journal of Neurovirology. 2019 Aug;25(4):589-596. DOI: 10.1007/s13365-019-00758-7.
  26. Kretowska-Grunwald A, Krawczuk-Rybak M, Sawicka-Zukowska M. Intravenous immunoglobulin-induced aseptic meningitis – a narrative review of the diagnostic process, pathogenesis, preventative measures and treatment. J. Clin. Med. 2022;11(13):3571. DOI: 10.3390/ jcm11133571.
  27. Leuci S, Coppola N, Cantile T, Calabria E, Mihai LL, Mignogna MD. Aseptic Meningitis in Oral Medicine: Exploring the Key Elements for a Challenging Diagnosis: A Review of the Literature and Two Case Reports. Int. J. Environ. Res. Public Health. 2022;19(7):3919. DOI: 10.3390/ ijerph19073919.
  28. Ruvinsky RO, Schindler Y, Urman G, Cortés Lopera L, Carrano J, Paolillo AL. Streptococcus pyogenes meningitis: a pediatric case report. Arch Argent Pediatr. 2020;118(3):e309-e312. DOI: 10.5546/aap.2020.e309.
  29. Golubovska OA, Andreychyn MA, Shcurba AV. Infectsiyni khvoroby: pidr. Vid 4, pererob. i dopov. Kiyiv: VSV «Medicina»; 2022. 464 s. [in Ukrainian].
  30. Manyelo CM, Solomons RS, Walzl G, Chegou NN. Tuberculous meningitis: pathogenesis, immune responses, diagnostic challenges, and the potential of biomarker-based approaches. Journal of Clinical Microbiology. 2021;59(3):e01771-20. DOI: 10.1128/jcm.01771-20.
  31. Lindland ES, Solheim AM, Andreassen S, Quist-Paulsen E, Eikeland R, Ljøstad U, et al. Imaging in lyme neuroborreliosis. Insights into Imaging. 2018;9:833-844. DOI: 10.1007/s13244-018-0646-x.
  32. Pagliano P, Ascione T, Boccia G, De Caro F, Esposito S. Listeria monocytogenes meningitis in the elderly: epidemiological, clinical and therapeutic findings. Le Infezioni in Medicina. 2016 Jun 1;24(2):105-11.
  33. Góralska K, Blaszkowska J, Dzikowiec M. Neuroinfections caused by fungi. Infection. 2018 Aug;46(4):443-459. DOI: 10.1007/s15010- 018-1152-2.
  34. Corrêa-Moreira D, Castro R, da Costa GL, Lima-Neto RG, Oliveira MME. Cerebrospinal fluid: a target of some fungi and an overview. Mem Inst Oswaldo Cruz. 2023 Mar 20;118:e220251. DOI: 10.1590/0074-02760 220251.
  35. Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A, et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol. 2017 Jan;13(1):13-24. DOI: 10.1038/ nrneurol.2016.167.
  36. Pasquier E, Kunda J, De Beaudrap P, Loyse A, Temfack E, Molloy SF, et al. Long-term mortality and disability in cryptococcal meningitis: a systematic literature review. Clin Infect Dis. 2018 Mar 19;66(7):1122-1132. DOI: 10.1093/cid/cix870.
  37. Zhdan VM, Lytvynenko NV, Silenko GY, Pinchuk V, Purdenko TY. Sudynni zahvoruvannya golovnogo mozku v praktici simeynogo likarja: navch. posib. dlya likariv-interniv, kursantiv, praktichnih likariv z fahu “zagalna praktichna medicina”. Poltava: UMSA; 2017. 123 s. [in Ukrainian].
  38. Lidove O, Chauveheid MP, Caillaud C, Froissart R, Benoist L, Alamowitch S, et al. Aseptic meningitis and ischaemic stroke in Fabry disease. Int J Clin Pract. 2009 Nov;63(11):1663-7. DOI: 10.1111/j.1742-1241.2009.02115.x.
  39. Atula S. Nastanova 00739. Lumbalna punkciya [Internet]. [Cited 2018 Sep 19]. Available from: https://guidelines.moz.gov.ua/ documents/3528.
  40. Boedeker D, Shaddeau A. Herpes simplex meningitis presenting as headache in pregnancy: A case report. Case Rep Womens Health. 2022 Sep 15;36:e00451. DOI: 10.1016/j.crwh.2022.e00451.
  41. Alvarez JC, Alvarez J, Tinoco J, Mellado P, Miranda H, Ferrés M, et al. Varicella-Zoster virus meningitis and encephalitis: an understated cause of central nervous system infections. Cureus. 2020 Nov 20;12(11):e11583. DOI: 10.7759/cureus.11583.
  42. Shariati A, Didehdar M, Rajaeih S, Moradabadi A, Ghorbani M, Falahati V, et al. Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports. Ann Clin Microbiol Antimicrob. 2021 Jun 15;20(1):44. DOI: 10.1186/s12941-021-00452-9.
  43. Gnatyuk V, Pokrovska T. Aseptichniy gerpesvirusniy meningit u ditiny. Klinichna imunologiya. Alergilogiya. Infectologiya. 2019;5(118):33- 35. [in Ukrainian].

Publication of the article:

«Bulletin of problems biology and medicine», 2023 Issue 3, 170, 39-52 pages, index UDC 616.831.9-002:616-06:616-082

DOI:

10.29254/2077-4214-2023-3-170-39-52

2023 Issue 3, 170
algorithm diagnosis meningeal syndrome treatment
01.10.2023
Was this article helpful?
5
5

Leave a Reply

Your email address will not be published. Required fields are marked *


The reCAPTCHA verification period has expired. Please reload the page.