2. Summary for case!
9 month-old boy his head has
grown so big. He isn’t able to
keep his balance when sitting.
Before two month he was
admitted to hospital because of
high fever and drowsiness. His
eyeballs are turned downwards
slightly.
3. Objectives
• Identify Meninges & Meningitis.
• Causes of Meningitis.
• Topical signs for Meningitis & Septicemia.
• Pathophysiology of bacterial meningitis.
• What’s “TB meningitis” and its symptoms?
• Third cranial (Oculomotor) nerve palsy and the dorsal
midbrain syndrome (Parinaud syndrome).
• The relationship between the child’s present
in this case and Febrile disease.
• Meningitis & Septicemia.
4. Meninges & Meningitis
• The meninges are three
layers of protective
tissue that surround the
brain and spinal cord.
• Meningitis: is a serious
inflammation of the
meninges.
Anything ends with “itis” it means inflammation
such as Appendicitis and Tonsillitis *
5.
6. • Septicemia is an infection of the blood often caused
by bacteria. It knows as blood poisoning.
• Unfortunately, in this case the infection its won’t
affect the meninges membrane only but also it will
affect the “Cerebrospinal Fluid” (CSF).
Meningitis & Septicemia
together they are deadly combination.
Septicemia vs. Meningitis
9. Topical sign for each !
Meningitis
• Stiff Neck.
• Dislike of bright
lights
“Photophobia”.
• Worsing
Headache.
• Severe muscle
pain.
Septicemia
• Diarrhea.
• Stomach cramps.
• Rash.
Hydrocephalus
• Drawsiness.
• Difficulty in
walking.
• Double vision.
• Slowing of
mental capacity.
• Headaches
• Neck pain
10.
11. Tuberculous meningitis
• The symptoms of TB meningitis start slowly, with the first
stage of symptoms lasting one to two weeks.
• It affects the meninges, which are membranes that cover the
brain and spinal cord.
• It’s caused by the bacteria Mycobacterium tuberculosis.
• Pathology of TB : Infection begins in the lungs
(usually pulmonary tuberculosis), and may spread
to the meninges by a variety of routes such as by
blood stem.
12. TB Meningitis symptoms
Early Symptoms
• patients can have a low-grade
fever, which is a fever higher
Intermediate Symptoms
• As TB meningitis progresses to
the intermediate stage, that
patients have increased pressure
inside their skulls.
• Seizures can develop with TB
meningitis in which the infection
disrupts the brain's electrical
activities.
• With third cranial nerve palsy,
patients have problems moving
their eyes up and down
13. The dorsal midbrain syndrome
(Parinaud syndrome)
• In the presence of increased CSF (due to
reduced flow or absorption), there is 3rd
ventricular dilatation.
• That will increased intracranial pressure can
cause paresis of cranial nerves III, IV, and VI,
and leading to deficiency in dorsal
midbrain.
• Baby's eyes appear to be looking down; it
characterized by increased intracranial
pressure (ICP). The name of this condition is
“Setting-sun sign”.
14. The structure of cranial nerves
“Inferior view of the human brain”
15. Oculomotor nerve palsy
• Third cranial nerve palsy is associated with weakness of
several eye muscles; this makes it very difficult to treat.
• An acquired isolated oculomotor nerve palsy in a child is
resulting of tumor, by viral illness, bacterial meningitis.
• The usual clinical sign of a third nerve palsy in
child is slightly the eyelid is droopy (ptotic)
downward location of the involved eye.
16. Superior Rectus muscle
Inferior Rectus muscle
Medial Rectus muscle
Inferior Oblique
Extraocular Muscle
Cont..
Damage to the extraocular muscles results in
downward and lateral deviation of the eye *
17. Fever is the response of
your body fighting an
infection, but if the body is
not under control that will
lead to something called …“Febrile seizure”
18. Febrile disease
• Febrile disease are full-body convulsions caused by high fevers
but without evidence of intracranial infection and common in
children between 3 months and 5 years of age.
• last <15 minutes, are generalized,
and occur only once per 24 hours.
Simple febrile
• last >15 minutes, have a focal
onset, or occur more than once per
24 hours.
Complex febrile
• differ in some other way from the
above, such as a lower
temperature than usual, unusual
age of the child.
Atypical febrile
19. Cont ..
• During the early stages of bacterial meningitis, seizures result
from swelling and pressure in the brain, as well as bacterial
toxins in the fluid surrounding the brain.
• Bacterial meningitis may also cause a condition that prevents
the body from eliminating fluids properly, which can cause
the sodium level in the blood to drop.
20. summary
• What does meningitis mean?
• How its effect brain?
• Its signs and symptoms.
• Meningitis with Febrile disease.
• Name of the abnormality of eye movement and
how its occur?
“the eyes resemble the sun setting below the horizon”
The oculomotor nerve is susceptible to injury at several points along its course to the orbit. The oculomotor fibers exit the midbrain within the interpeduncular fossa. Displacement of the cerebral peduncle, as seen with temporal lobe herniation, may lead to compression of this nerve. After exiting the interpeduncular fossa, the oculomotor nerve courses between the posterior cerebral artery and superior cerebellar artery. Aneurysmal compression of the nerve at this level may present with isolated cranial nerve III palsy. The oculomotor nerve continues through the cavernous sinus and may suffer from injury at this site when there is cavernous sinus infection, venous thrombosis, or mass lesion. Cavernous sinus pathology, however, typically results in the paralysis of multiple cranial nerves, including the trigeminal (V1 and V2), trochlear (CN IV), and abducens (CN VI) nerves. In addition, carcinomatosis or infectious processes, such as tuberculous meningitis involving the optic chiasm, temporal lobes, or pons, may also affect the oculomotor nerve (Figure 11).
