Management of meningeal signs in children

This slideshow helps to better management of meningeal signs in children

1. Fariba shirvani MD Management of meningeal signs in children

2. Definition: Signs and symptoms of meningitis in children The 3 classic symptoms (less likely in younger children): Fever Headache Meningeal signs

3. What are meningeal signs

4. Meningeal signs N eck pain Meningeal irritation : Brudzinski sign , Kernig sign, tripod phenomenon, or neck stiffness in children older than 1 year. In children 1 year or younger: bulging fontanel

5. Clinical signs of meningeal irritation

6. Disorders accompanied with meningeal signs in children:

7. Scoring for bacterial meningitis: Total Score = [1 × Duration of Main Problem (1 Point for Each Day)] + [2 × Vomiting in History (Yes = 1; No = 0)] + [7.5 × Meningeal Irritation (Yes = 1; No = 0)] + [6.5 × Cyanosis (Yes = 1; No = 0)] + [4 × Petechiae (Yes = 1; No = 0)] + [8 × Disturbed Consciousness (Yes = 1; No = 0)] + [0.1 × Serum C-reactive Protein (CRP) (per 10 mg/L)]. Oostenbrink  RMoons  KGMDonders  ARTGrobbee  DEMoll  HA Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures.  Acta Paediatr. 2001;90611- 617

8. Scoring for bacterial meningitis: . In those with a risk score of less than 9.5 points (approximately 35% of the patients), bacterial meningitis seemed always to be absent. In the remaining patients with(score , ≥9.5), the risk of bacterial meningitis was 44%. Oostenbrink  RMoons  KGMDonders  ARTGrobbee  DEMoll  HA Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures.  Acta Paediatr. 2001;90611- 617

9. Bacterial meningitis score Components of the bacterial meningitis score   are as follows: Positive CSF Gram stain CSF absolute neutrophil count 1000/µL or higher CSF protein level 80 mg/ dL or higher Peripheral blood absolute neutrophil count 10,000/µL or higher History of seizure before or at the time of presentation Meta-analysis of bacterial meningitis score validation studies. Arch Dis Child.  2012; 97(9):799-805  (ISSN: 1468-2044) Nigrovic  LE; Malley  R; Kuppermann  N

10. What are the predictors of bacterial meningitis CSF indices: identified the absolute PMN cell count CSF–blood glucose ratio independent determinants of presence of bacterial meningitis.

11. What are the predictors of bacterial meningitis patient characteristics: duration of the main problem , vomiting , meningeal irritation , cyanosis , petechiae , disturbed consciousness, and serum CRP , can discriminate well between the absence or presence of bacterial meningitis

12. Contraindication of LP

13. (1) a short period of antibiotic therapy prior to LP does not change cerebrospinal fluid (CSF) white blood cell count, protein, or glucose; (2) the yield of CSF gram stain and culture may be somewhat reduced by a short period of antibiotic therapy, but these tests often remain positive; and (3) adjunctive tests, including blood cultures and CSF antigen tests, can often independently identify the bacterial meningopathogen . The available evidence suggests that if bacterial meningitis is suspected and LP must be delayed, intravenous antibiotics are warranted before CSF is obtained.

14. Treatment

15. Duration of Treatment