Edema of meninges

Toxicoinfectious cerebral edema(primary rhinosinusogenic hydrocephalus) in most patients begins acutely against a background of sinusitis and from the first moments the disease is accompanied by severe headache and vomiting. A few days before, some have noted malaise, evenings chills and headaches. Concurrent acute sinusitis or exacerbation of the chronic process in the sinuses does not present any peculiarities.

In the future, a symptom of a headache,accompanied by nausea and vomiting, begins to dominate the complaints of patients, their localization is often limited to the forehead and temples area [Kuranov NI 1971]. Soon you can find stagnant nipples of the optic nerves, as well as reduced visual acuity. As a rule, a pronounced neurologic syndrome is defined.

Of the disorders of the cranial nerves are characteristicsigns of defeat of the leading, oculomotor and trigeminal nerves. There may be paralysis with a decrease in muscle tone; pathological reflexes of the feet, sometimes there are epileptiform seizures. Meningeal syndrome is not true for toxic edema of the brain envelopes true, but has the character of mini-digest [Dainiak LB et al. 1975]. According to the opinion of AV Fotin and NL Voznesensky (1971), with primary rhinosinusogenic hydrocephalus hyperproduction of cerebrospinal fluid occurs in response to the toxic effect of the inflammatory process in the paranasal sinuses. Spinal puncture data indicate an increase in the fluid pressure of 2.06-4.41 kPa (210-450 mm Hg), a decrease in the amount of protein without increasing the number of cellular elements (3 - 5 * 10 6 / l).

According to clinicians, the emergence of serousmeningitis in children is usually explained by increased permeability of blood vessels and brain envelopes, as well as imperfection of the function of the blood-brain barrier. Serous meningitis develops as a result of the penetration of toxins or malovirulent microbes and viruses into the subarachnoid space. It is an irritation of the soft meninges, accompanied by a significant increase in the production of cerebrospinal fluid. Along with the increase in intracranial pressure, there may be limited serous swelling of the brain substance in the form of inflammatory edema - serous meningoencephalitis.

The process, as a rule, in young children develops with etmoiditis or antritemia, and in older children - also with lesions of the frontal sinuses [Blagoveshchenskaya N. S, 1972].

In children, serous meningitis is very acute with a body temperature reaching 39-40 ° C.

Increased intracranial pressure and serousmeningo-encephalitis cause the appearance of a number of symptoms, characteristic for the defeat of the central nervous system. Along with a headache accompanied by frequent nausea and vomiting, a meningeal syndrome arises - most characteristic are stiff neck muscles and Kernig's symptom, the symptoms of Brudzinsky (upper, or occipital, pubic and contralateral), Guillain, general hyperesthesia and sense organs, as well as specific position of the patient in bed. No less characteristic manifestation is the defeat of cranial nerves with their paresis, sensitivity disorders and secretory disorders. However, in serous meningitis, all the symptoms mentioned are relatively mild and, in contrast to single-valued meningitis, are combined with a favorable course of the disease.

One of the main criteria for the differential diagnosis of serous and purulent forms of inflammation of the meninges is the data from the cerebrospinal fluid.

Patients with serous meningitishigh blood pressure, it is always clear, cytosis ranges from 20 to 800 * 10 6 / l; as a rule, a moderate increase in protein is observed, and in bacteriological analysis the liquid is always sterile.


"Inflammation of the paranasal sinuses in children,
M.Ya. Kozlov

A more informative method of additionalThe examination is an electrophysiological method - rheoencephalography. The analysis of the obtained synchronous rheograms in hemispheric and regional leads makes it possible to establish interhemispheric rheograms.

To the group of non-nasal forms of intracranialArachnoiditis belongs to rhinosinusogenic complications. Pathological-anatomically, arachnoiditis is the formation of adhesions between the arachnoid and underlying soft-tissue with involvement.