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Abstract: The patient had a headache with fever onset and a severe headache. After admission, physical examination showed positive cervical tonicity, and acute meningitis was considered by lumbar puncture examination. Meningitis is mainly a disease caused by bacteria, viruses and other microorganisms entering the cranium through the blood-brain barrier and involving the meninges. The patient’s symptoms improved after treatment with anti-inflammatory and anti-viral drugs, cerebral protection, and dehydration to lower intracranial pressure.
Basic information】Male, 34 years old
Type of disease】Acute meningitis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (cerebroprotein hydrolysate for injection + ceftriaxone sodium for injection + ganciclovir injection + wake-up call injection + mannitol injection + antelope horn capsule)
[Treatment period] 10 days of hospitalization
Treatment effect】Headache and fever symptoms have been relieved
I. Initial consultation
Three days before admission, the patient had a fever with headache without any obvious cause, with a temperature of up to 39.5℃, a severe headache, bilateral temporal and frontal distension and pain, and a feeling of explosion in the head, accompanied by nausea and vomiting, vomiting three times in the form of jet vomiting, and vomiting the contents of the stomach, but no symptoms of weakness of the arms and legs, speech disorders, or convulsions. Initially, he thought it was a common cold and did not pay attention to it. After taking oral cold medicine by himself, he did not see any relief of headache and his body temperature gradually decreased to 38℃. The patient came to the hospital with his family, and a head CT examination showed no significant abnormality. The preliminary diagnosis was fever and headache to be investigated, and the patient was told that he needed to be admitted for further examination, to which he gave informed consent.
II. Treatment history
After admission, the patient was found to be conscious, with normal speech, body temperature of 37.9℃, blood pressure of 130/85mmHg, heart rate of 71 beats/min, respiration of 19 breaths/min, positive cervical ankylosis, positive Creutzfeldt-Jakob sign, positive Bruch’s sign, head magnetic resonance examination showed punctate ischemic foci in the brain, EEG examination showed limbic state EEG, lumbar puncture examination showed cerebrospinal fluid sugar of 2.67mmol The lumbar puncture showed cerebrospinal fluid glucose of 2.67 mmol/L, cerebrospinal fluid chloride of 124.0 mmol/L, cerebrospinal fluid pressure of 280 mmH2O, cerebrospinal fluid albumin of 1027 mg/L, and cerebrospinal fluid cell count of 20. After communicating with the patient and family, acute meningitis was considered. The patient’s family agreed, and the patient was given injectable cerebral protein hydrolysate to improve cerebral metabolism, injectable ceftriaxone sodium for anti-inflammation, ganciclovir injection for anti-virus, waking brain static injection for cerebral protection, mannitol injection for dehydration and lowering intracranial pressure, and oral antelope horn capsule for symptomatic pain treatment.
III. Treatment effect
Through 10 days of treatment, the patient’s body temperature dropped to normal, and the headache symptoms were significantly relieved, with only occasional mild pain and throbbing sensation in the temporal region bilaterally, without nausea, vomiting and speech disorder. The patient was hospitalized for 7 days, and a repeat lumbar puncture showed cerebrospinal fluid sugar of 2.88 mmol/L, cerebrospinal fluid chloride of 121.0 mmol/L, cerebrospinal fluid pressure of 180 mmH2O, cerebrospinal fluid albumin of 329 mg/L, and cerebrospinal fluid cell count of 5. The results of the lumbar puncture indicated that the condition was well controlled and met the discharge index, and discharge was granted.
IV. Notes
We are glad that the patient was cured of acute meningitis after treatment. However, the patient still needs to pay attention to the change of body temperature after discharge. Generally, the body temperature does not exceed 38.5℃, and there is no need to inject antipyretic injection or take symptomatic antipyretic medicine. Low fever is a protective measure for the body, regulating the body’s immune function against infection, but high fever requires physical cooling combined with antipyretic drugs to avoid causing febrile convulsions and acute meningitis is prone to recurrence. After discharge, family members need to pay attention to the patient’s state of consciousness and the presence of convulsive episodes, which are manifestations of brain parenchymal injury. If the patient has nausea and vomiting symptoms, pay attention to the need to tilt the head to the side when vomiting, actively clean up the secretions in the mouth to avoid accidental aspiration, and go to the hospital in a timely manner.
V. Personal insight
The condition of acute meningitis is rapidly changing, with clear consciousness before onset and sudden onset of unconsciousness after the onset of nausea and vomiting, as in the patient in this case, who was clearly conscious and showed headache at the time of examination, but when his intracranial pressure increased, he could present frequent jet vomiting, which could lead to misaspiration if he was not careful. Treatment of acute meningitis usually takes about 3 weeks, and after treatment, a lumbar puncture needs to be repeated to see the indicators. The vast majority have a good prognosis and generally do not leave sequelae, but they need to be differentiated from other diseases, including post-infection headache, cerebral hemorrhage, and neurogenic headache.