A child with a stiff neck

Anatomy
1. Skull
2. CSF
  1. Secretion
    1. From the choroid plexus, which are found on the lateral ventricles, roof of the 3rd ventricle, and the 4th ventricle
  2. Absorption
    1. Absorbed from the superior sagittal sinus through the arachnoid villi
  3. Circulation
    1. Through the ventricular system
3. Meninges
4. Ventricular system
  1. Lateral ventricles
    1. 3rd ventricle
      1. 4th ventricle
  2. Foramen of Monro
    1. Cerebral Aqueduct
      1. Central canal
Meningitis
1. Pathology
  1. 1. penetrate the blood-brain barrier
    1. 2. endotoxin and inflammatory mediators
      1. 3. leakage of protein and fluid out of the cerebral vasculature
        4. causing cerebral edema , increase intracranial pressure
        5. lead to a reduction in cerebral perfusion
        6. Brain death
2. Management
  1. Newborn
    1. Adult
      1. Elderly
        Ampicillin + vancomycin + 3rd generation cephalosporin
      2. Vancomycin + 3rd generation cephalosporins
    2. Ampicillin + 3rd generation cephalosporin + Aminoglycoside
3. Physical examinations
  1. Neurological examinations
  2. General inspection
  3. Meningeal signs
    1. Kernig's sign
      1. Brudzinski's sign
  4. Vital signs
4. Investigations
  1. Lumbar Puncture
    1. In Infants: L4-L5 interspace
      1. In Adults: L3-L4 interspace
    2. Indications
      1. Anesthesia
      2. Therapeutic
        Injection of Drug (Antibiotic, Chemotherapy)
      3. Diagnostic
        Sample CSF (Infections, Cancers, Subarachnoid Hemorrhage, Neurologic Disorders)
        Measure pressure
    3. Contra-indications
      1. Increased intracranial pressure
        Infections at the level of insertion
        Uncorrected Coagulopathy
    4. Complications
      1. Severe headache
        Hemorrhage
        Back pain
5. Signs and symptoms
  1. Fever
    1. Headache
      1. Neck stiffness
        Photophobia
6. Causes
  1. Infectious
    1. Bacterial
      1. Neisseria Meningitidis
        Listeria monocytogens
        H.Influenza
        Streptococcus agalactiae
    2. Viral
      1. Enterovirus
        Cocxakie virus
        Echovirus
    3. Fungal
      1. Cryptococcus newformans
  2. Non-infectious
    1. injury (head trauma), drugs and cancer

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A child with a stiff neck

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	Created by fatima alkhateeb almost 6 years ago

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