Differential diagnosis 1. Other purulent meningitis can be initially distinguished according to the route of invasion, pneumococcal meningitis mostly secondary to pneumonia;, otitis media based, staphylococcal meningitis mostly occurs in the course of staphylococcal sepsis; gram-negative bacillus meningitis easily occurs after cranial surgery; influenza bacillus meningitis mostly occurs in infants and children; pseudomonas aeruginosa meningitis often secondary to lumbar puncture, anesthesia, contrast or surgery After the surgery. 2, epidemic B encephalitis onset season is mostly in July to September, brain parenchymal damage is serious, coma, convulsions are common, skin is generally no petechiae, cerebrospinal fluid is more clarified, cell count is mostly below 500/mm, sugar and protein amount is normal or slightly increased, chloride is normal, immunological examination such as specific IgM, complementary junction test, etc. can help identify. 3, false meningitis septicemia, typhoid fever, lobar pneumonia and other acute infections in patients with severe toxemia, can appear meningeal irritation signs, but the cerebrospinal fluid, except for slightly increased pressure, the rest are normal. 4, toxic bacterial dysentery is mainly seen in children, the onset of the season in summer and autumn, a short period of high fever, convulsions, coma, shock, respiratory failure and other symptoms, but no petechiae, cerebrospinal fluid examination is normal, confirming the diagnosis relies on fecal bacterial culture. 5.Subarachnoid hemorrhage is common in adults, with sudden onset, mainly severe headache, followed by coma in severe cases, body temperature often does not rise, meningeal irritation signs are obvious, but no skin mucosal petechiae, petechiae, no obvious signs of toxicity, cerebrospinal fluid is bloody, cerebral angiography can find aneurysms, vascular malformations and other changes. Treatment 1. Application of dehydrating agents The following drugs should be applied alternately or repeatedly: (1) 20% mannitol. (2) 25% sorbitol. (3) 50% glucose. (4) 30% urea. The above drugs should be administered intravenously at 4-6 hour intervals by rapid drip or static push until blood pressure returns to normal, pupils on both sides are equal in size, and breathing is stable. After using dehydrating agent, rehydrate appropriately to maintain the patient in a mildly dehydrated state. Adrenocorticotropic hormone can also be applied at the same time to reduce toxemia and lower intracranial pressure. 2.Sub-hypnotic therapy is mainly used for those with high fever, frequent convulsions and obvious cerebral edema to reduce brain water content and oxygen consumption and protect the central nervous system. Thorazine and promethazine are injected intramuscularly or pushed quietly, and ice bags are placed behind the occiput, neck, axilla or groin to lower the body temperature to about 36℃. Later, re-inject intramuscularly every 4-6 hours for a total of 3-4 times. 3, the treatment of respiratory failure should focus on the prevention of cerebral edema. If respiratory failure has already occurred, in addition to dehydration, central nervous system stimulants such as Lopressor, Coramin, Kisuling, etc. should be given. Scopolamine hydrobromide can also be used for sedation to improve cerebral circulation, stimulate breathing and sedation. If necessary, tracheal intubation should be performed to aspirate sputum and secretions, supplemented by artificially assisted breathing until the patient resumes automatic breathing.