DISODERS OF NEUROLOGICAL SYSTEM

1. Meningitis
In
Children

2. Definition
Meningitis is the inflammation of the
membranes surrounding the brain & spinal
cord, including the dura, arachanoid & pia
matter.

3. Incidence
 Meningitis can occur at all ages but it is
commonest in infancy. While 95% of the
cases take place between 1 month- 5
years of age.
 It is more common in males than females.

4. Predisposing factors
 Immuno - suppressive drugs.
 Diabetes mellitus and malignancies.
 Immuno-compromised children.
 Trauma or invasive procedure.

5. CLINICAL FEATURES
In neonates
 Poor feeding.
 Vomiting.
 Diarrhea.
 Lethargy.
 Weak cry.
 Sleepiness.

6. In infants
 Fever
 Irritability
 Poor feeding
 Vomiting
 High pitch cry
 Seizures
 Bulging fontanels
 Neck rigidity
CLINICAL FEATURES

7. Children
 Flu-like symptoms.
 Fever.
 Lethargy.
 Altered consciousness.
 Irritability.
 Photophobia.
 Stiff neck.
 Skin rashes .
 Seizures.
 Headache.
CLINICAL FEATURES

8. POSITIVE KERNIG’S SIGN-
Straightening of leg at knee causes active resistance
and back pain

9. POSITIVE BRUDZINSKI’S SIGN
Flexion of neck there is involuntary bending of hip and
knees

10. Types
 Bacterial
 Viral (aseptic)
 Fungal
 Parasitic
 Tubercular

11. Bacterial Meningitis
 Caused by a wide variety of pyogenic bacterias
like….
 Hemophilus influenza
 Meningococcus
 Pneumoccous
 Streptococcus
 Often followed by bacteremia.

12. Viral meningitis
 The viral agents for aseptic meningitis include
the following:
 Enterovirus (polio virus, Echovirus,
Coxsackievirus )
 Herpesvirus (Hsv-1,2, Varicella.Z,EBV )
 Paramyxovirus (Mumps, Measles)
 Togavirus (Rubella)
 Rhabdovirus (Rabies)
 Retrovirus (HIV)

13. Fungal Meningitis
 It’s rare in healthy people.
 But is a higher risk in those who have AIDS,
other forms of immunodeficiency or
immunosuppression.
 The most common agents are Cryptococcus
neoformans, Candida, H capsulatum.

14. Parasitic Meningitis
 It’s more common in underdeveloped countries
and usually is caused by parasites found in
contaminated water, food, and soil.
 The most common causative agents are:
 Free-living amoebas (ie, Acanthamoeba,
Balamuthia, Naegleria)
 Helminthic eosinophilic meningitis

15. Tubercular meningitis
 Caused by mycobacterium tuberculi.
 It’s a complication of Childhood tuberculosis &
common cause of prolonged morbidity, handicap
& death.
 Children below 5 years are specially prone.

16. Diagnosis
 Lumbar Puncture shows elevated pressure.
 CSF examination shows
 Cloudy CSF.
 Raised WBC.
 Raised Proteins.
 Glucose less than 50mg/dl in most cases.
 Culture for tubercle bacilli.
 CXR.
 Tuberculin skin test.

17. TREATMENT
 SPECIFIC THERAPY:
IV antibiotics on the basis of C&S report
of CSF.
Eg. Penicillin, Vancomycin, Cefotaxime.

18. Antitubercular Therapy:
Includes simultaneous administration of 4
drugs (Isoniazid, rifampicin, streptomycin ,
pyrazinamide) for first 3 months, followed
by 2 drugs for another 15 months usually
Rifampicin & INH.

19. SYMPTOMATIC TREATMENT
 SEIZURE MANAGEMENT:
• Phenobarbitone
• Diazepam
• Dilantin
 INCREASED ICP:
• Mannitol
• Furosemide
 FEVER AND HEADACHE:
• Aspirin
• Acetaminophen

20. Supportive therapy:
 Maintain fluid & electrolyte balance as
required.
 Neurological assessment.
 Temperature control.

21. Prevention
 The vaccines against Hib, measles,
mumps, polio, meningococcus, and
pneumococcus can protect against
meningitis.

22. NURSING MANAGEMENT
 Isolation
 Administration of drugs
 Control seizures and protect the child from injury
 Maintain fluid and electrolyte balance
 Provide rest and comfort.
 Parental guidance and support

23. THANK YOU