Eng / Meningeal syndrome
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Pathogenesis of
edema - swelling of the brain
Toxic damage to cerebral vessels
Microcirculatory disorders
Brain hypoxia
Increased BBB permeability
Entry into cells of sodium and water
An increase in the volume of the brain in a confined space leads to the dislocation of the medulla oblongata with the descent of the cerebellar tonsils into the foramen magnum (death from respiratory paralysis).
edema - swelling of the brain
Severe headache, stupor, drowsiness, disorientation, restlessness.
Disturbances of consciousness from mild confusion to deep coma
Clonic-tonic convulsions
The pupils are initially narrow, then dilated, anisocoria, strabismus, nystagmus.
The face is cyanotic or pale, muscle tone is increased by the type of decerebrate rigidity, meningeal signs are pronounced.
Urination is delayed.
With the progression of edema, the reflexes fade, muscle tone drops, meningeal signs disappear, and the reaction of the pupils to light disappears.
There are violations of the heart rhythm - more often bradycardia, less often tachyarrhythmia.
Blood pressure is initially elevated, in the terminal stage it falls. Respiratory activity is disturbed, tachypnea and progressive cyanosis occur. Death comes from respiratory arrest.
Diagnostics
1.Examination of the fundus - congestive changes in the optic discs with long-term intracranial hypertension.
2.CT allows you to identify a decrease in the density of the medulla, to assess the severity of edema, its prevalence.
3.MRI makes it possible to determine areas of hyperhydration of the medulla.
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Therapy ONGM
1.Antimicrobial therapy, the effectiveness of which is determined by:
A sharp decrease in lactate from 10-20 to 3-6 mmol / l with the suppression of the bioactivity of the pathogen
An increase in glucose levels to the lower limit of normal
Increase in CSF pH to 7.1
A decrease in fibrin D-dimer from 10-15 to 3-5 µg/l indicates the completion of lysis
A decrease in the protein level by 1.5-2 times indicates the stabilization of the hematoliquor barrier
Therapy ONGM
2. Dehydration
loop diuretics with obligatory control of BCC
osmodiuretics act more physiologically, but there may be a recoil syndrome
3. GKS 4.IVL
5 drugs that improve cerebral blood flow
6.Antioxidants
7.Antihypoxants
8.mechanical cooling of the brain
Н.Н. Бурденко
«Who owns the art of preventing and treating cerebral edema, he owns the key to the life and death of the patient "
THANK YOU FOR YOUR
ATTENTION!