Morales meningitis in children
Introduction
Introduction to pediatric Moraley meningitis Morare meningitis is a benign, recurrent, self-limiting aseptic meningitis that is rare in clinical practice, also known as benign recurrent meningitis, benign recurrent aseptic meningitis (benignrecurrentasepticmeningitis) It is an acute, benign, aseptic meningitis syndrome, once called "benign recurrent endothelial leukocytitis meningitis syndrome", and later named Mollaret meningitis. This symptom is a transient meningitis episode that alternates with asymptomatic intermittent. basic knowledge The proportion of illness: the incidence rate of infants and young children is about 0.004%-0.005% Susceptible people: children Mode of infection: non-infectious Complications: convulsion in children, coma
Cause
The cause of malaure meningitis in children
Caused by viral infection (30%):
Mollaret meningitis may be caused by a viral infection. Herpes simplex virus (HSV1), HSV1-DNA, has also been found in the cerebrospinal fluid of patients, and evidence of EB virus infection has also been found. Recently, it has also been suggested that Mollaret meningitis has a similar pathogenesis to recurrent polyserositis. Mollaret meningitis is only one of the manifestations of polyserositis in a certain organ.
Caused by cell shedding (30%):
Some people think that Mollaret meningitis is caused by the shedding of neurocutaneous dermoid cysts or similar tumor cells. The cholesterol that is introduced into the subarachnoid space in the exfoliated cell debris can cause chemical stimulation, leading to short-term meningitis.
The role of immune factors (30%):
Immunological factors also play a role in the pathogenesis of Mollaret meningitis. T lymphocyte conditioning function is abnormal, complement C1 is deficient, and levels of cytokines (such as IgG, IL-6, TNF-, PGE2, etc.) are increased.
Prevention
Child Morare meningitis prevention
Actively prevent and cure viral infectious diseases and do various vaccinations.
Complication
Pediatric Morare meningitis complications Complications, convulsions and coma in children
Convulsions, hallucinations, coma, diplopia, etc. can occur during the attack. Do not leave sequelae after stopping the attack.
If the treatment is not appropriate, the lesion can be changed from acute to chronic, and the following sequelae can occur:
Hydrocephalus
Due to meningeal adhesions, cerebrospinal fluid circulation disorders;
2. Cranial nerve damage paralysis
Such as deafness, visual impairment, strabismus, facial nerve spasm, etc.;
3. Brain vasculitis causes luminal obstruction
Causes cerebral ischemia and infarction at the corresponding site.
Symptom
Pediatric Morare meningitis symptoms Common symptoms Recurrent headaches Nausea and vomiting Neck stiffness Straight back pain Meningeal irritation Diplopia Myocarditis Meningitis Facial paralysis
The disease is rare in clinical practice, mainly manifested as recurrent headache, fever, and meningeal irritation; there is no special cause for each episode, and there is no aura. The form of each episode is very similar to the clinical manifestations; the interval of seizures varies, the episode With rapid regression, the number of episodes is unpredictable; nearly 50% of patients may have different manifestations of temporal and parenchymal brain damage; the course of disease is self-limiting and the prognosis is good.
The symptoms are more common in small babies, sudden onset, symptoms within a few hours to reach the apex, fever, nausea, vomiting, headache, neck and back pain, myalgia, neck stiffness, gram and cloth signs positive, and some have convulsions, hallucinations, Coma, double vision, facial nerve paralysis, pupils are not large, Pap smear positive, etc., symptoms last 2 to 7 days, up to more than 20 days, then quickly disappeared, returned to normal, interval between days to 2 months, After several similar episodes in a few years, the episode can be suddenly stopped without leaving sequelae.
Examine
Examination of children's Morare meningitis
In the first day of the episode, cerebrospinal fluid examination showed large mononuclear cells or a large number of endothelial cells, and the number of leukocytes increased to several thousand. It was mainly composed of neutral and large fragile endothelial cells. After one day, it became mononuclear and lymphatic. Mainly, after a few days, the cells are rapidly reduced, the mild protein is increased, the sugar can be normal or reduced, and a large number of endothelial cells in the cerebrospinal fluid are important features of this disease. Heramns proposed that endothelial cells account for more than 66% of the total cells and have diagnostic value, no bacteria.
Brain B-ultrasound at the time of onset, CT examination showed increased intracranial pressure and cerebral edema.
Diagnosis
Diagnosis and identification of children's Morare meningitis
diagnosis
The current diagnosis of this disease is mainly based on the diagnostic criteria proposed by Bruyn in 1962:
1. Repeated meningitis symptoms: repeated fever with meningeal irritation, each episode lasts 3 to 7 days, there is fever at the onset, the onset of headache, neck and back pain, myalgia, neck and back, Brine, The gram is positive, the symptoms reach a peak several hours after the onset, and the symptoms suddenly disappear after several days.
2. Intermittent seizures: There are no symptoms or signs between the two episodes, and the symptoms of meningitis come and go suddenly.
3. Increased number of cerebrospinal fluid cells in the attack: including endothelial cells, neutrophils, and lymphocytes.
4. The course of disease is self-limited without sequelae: repeated attacks, generally do not affect health.
5. Application of modern inspection techniques: no pathogenic microorganisms can be found. Evans believes that the laboratory is characterized by large and regular cerebrospinal fluid, unclear cytoplasmic and nuclear nucleus, and easily broken mononuclear cells, namely Mollaret cells. Mollaret cells are thought to appear within hours of onset and are rarely seen after 24 hours.
Differential diagnosis
The onset of this disease should be associated with purulent meningitis, tuberculous meningitis, viral meningitis, and novel cryptococcal meningitis; should be associated with recurrent suppurative meningitis, congenital anatomical defects such as meningocele, sinus Recurrent meningitis caused by Dao et al., recurrent episodes of chemical aseptic meningitis caused by intracranial and spinal cord dermatoses, and differentiation of Behcet's syndrome.
