儿科学课件（重庆医科大学）13惊厥7七年制儿科2015.ppt

When flexing the hip 90 degrees and then extending the leg, the patient feels subsequent pain. Bacterial Meningitis When passively flexing the neck while supine, patient involuntarily flexes his knees and hips. Bacterial Meningitis Meningitis in neonates and younger babies Clinical findings are nonspecific fever is often absent / hypothermia Sepsis-like manifestations (refusal of feedings, pale/grey skin) Not have obvious seizure and Increased intracranial pressure Hyperactivities, fixed eyes Vomiting, high pitched cry A full, tense, or bulging fontanel Bacterial Meningitis Signs of systemic infection Increased intracranial pressure meningeal irritation Typical (older children) Fever, altered consciousness, seizure Headache, vomiting, herniation nuchal rigidity, back pain, kernig sign, brudzinski sign Atypical (neonate 3mo infant ) Fever,normal temperature or hypothermia; minim or subtle seizure; poor feeding;less activity Scream,frown; bulging or full fontanel; widening of the sutures Not evident Comparison of the manifestations of meningitis between different age groups Bacterial Meningitis Laboratory Tests for Suspected Bacterial Meningitis Lumbar puncture to obtain CSF Cell count with differential Glucose protein levels (serum glucose level) Gram stain bacterial cultures Detection for specific antigens of bacteria Blood urine cultures for bacteria Brain CT or MRI scan for determining pathological area complications Bacterial Meningitis Laboratory Findings Analysis of CSF Suggestion bacterial meningitis High pressure Appearance: slightly cloudy to purulent an increased WBC count(1000X106/L, with neutrophil predominance Raised protein concentration ( 1g/L), decreased glucose concentration (50% of serum sugar concentration) Bacterial Meningitis Laboratory Findings Analysis of CSF Confirmation of the diagnosis: identify the organism Gram-stained smear of CSF: positive in 70-90% of cases CSF culture: positive in 80% of c