Clinical aspects of meninges

1. CLINICAL ASPECTS
OF MENINGES
Dr. Md. Saiduzzaman
MD Resident (Neurology) phase-B
MYMENSINGH MEDICAL COLLEGE

2. A) Developmental-
> Meningocele
> Meningomyelocele
B) Vascular-
> Subarrachnoid haemorrhage
> Dural venous sinus thrombosis.
> Dural A-V fistula.
c) Infective-
> Meningitis > Subdural Empyema
> Meningoencephalitis. > Epidural abscess.

3. d) CSF pressure defects-
> low- spontaneous intracranial hypotension (SIH)
> high- Hydrocephalus, IIH, CVST
e) Traumatic-
> Epidural haemorrhage
> Subdural haemorrhage
> CSF rhinorrhea
f) Tumour-
> Primary- Meningioma
> Secondary deposits

4. Causes:
• Ruptured Berry aneurysm
• AVM
• Perimesencephalic haemorrhage
C/F:
> Sudden severe thunderclap headache.
> Vomiting
> Neck stiffness

6. Haemorrhagic CSF in SAH.

9. DSA- Right MCA aneurysm.

10. Risk factors:
1. Thrombophilia- Protein C, Protein S , Antithrombin III deficiency.
2. Chronic inflammatory diseases- IBD, SLE, Behçet's disease.
3. Pregnancy and puerperium.
4. Haematological disorder- PRV, PNH, Sickle cell anaemia.
5. Nephrotic syndrome
6. Hormonal contraception.

13. Causes:
A) Infectious-
1. Viral
2. Bacterial
3. Tubercular
4. Fungal
5. Spirochaetal
B) Non-infectious-
1. Malignancy
2. Inflammatory diseases- Sarcoidosis.

16.  Collection o pus between the dura and arachnoid mater.
 Predisposing factors:
1. Sinusitis.
2. Head injury.
3. Neurosurgery.
4. Secondary infection of subdural effusion or haematoma.
C/F:
1. Fever
2. Progressively worsening headache.
3. Focal neurologic sign.
4. Seizure.
5. Neck rigidity

18. Spinal subdural abscess.

19. Collection of pus (infected material) between the dura mater of the brain and
spinal cord and the bones of the skull or spine.
Causes:
• Cranial:
1. Chronic ear infections 4. Mastoiditis
2. Chronic sinusitis 5. Recent neurosurgery.
3. Head injury
• Spinal:
1. Haematogenous
2. Spinal osteomyelitis
3. Spine surgery.

20. C/F:
Cranial:
1. Fever
2. Headache
3. Neck rigidity
4.Seizure.
Spinal:
1. Fever
2. Back Pain.
3. Bowel or bladder incontinence.

22. Cranial epidural abscess.

23. Spinal epidural abscess.

24. Cause:
Idiopathic spontaneous CSF leak.
C/F:
Headache (occipitofrontal headache, more in sitting or standing upright
position, improves in recumbent position)
Imaging:
- sagging of brain.
- dural enhancement.

26. Features:
 Occurs in 10-30% of patients following LP.
 More common in young female patients.
 Usually begins within 24 hours.
 Headache more in sitting or standing upright position.
 Relieves upon reclining or with abdominal compression.
Treatment:
Bed rest in recumbent position.
Adequate fluid intake.
Simple analgesia- Paracetamol, opioids.
IV caffeine, blood patch.

28. Hydrocephalus is an abnormal increase in the volume of the CSF within the skull.
It is due to one of the following:
(1) an abnormal increase in the formation of the fluid,
(2) blockage of the circulation of the fluid,
(3) diminished absorption of the fluid.
Types:
1. Non-communicating/ Obstructive
(blockage at some point between its formation at the choroid plexuses and its exit
through the foramina in the roof of the fourth ventricle.)
2. Communicating.

32. Bleeding occurs between the dura mater and skull.
Cause:
Trauma to the head causing arterial bleeding.
C/F:
> Altered level of consciousness
> Pupillary abnormality
> Respiratory arrest.

34. Bleeding occurs between dura and arachnoid mater.
More common in elderly.
Predisposing factors:
1. cerebral atrophy causing stretching of bridging veins.
2. Alcoholism
3. Coagulation disorder.
C/F:
1. Fluctuating level of consciousness.
2. Dementia.
3. Features of raised ICP.

37.  Arises from the dura mater.
 Composed of meningeal epithelial cells.
 Sites:
1. Over the cerebral convexities, especially adjacent to the sagittal sinus.
2. Skull base.
3. Dorsum of the spinal cord.
WHO histologic grading of increasing agressiveness:
1. Grade I (benign)
2. Grade II (atypical)
3. Grade III (malignant).

38. C/F:
1. Headache.
2. Seizure
3. Focal neurologic deficit.
4. Features of compressive myelopathy.

41. Common primary sites:
1. GIT malignancy
2. Papillary Thyroid carcinoma
3. Breast carcinoma.
4. Leukaemia.
5. Lymphoma.
6. Primary Brain Carcinomas.

42. Meningeal Metastasis from Papillary thyroid carcinoma.