Meningeal irritation

Soft outlined by the meningeal inflammation. bleeding or physical and chemical environment within the changing stimulation, there will be a series of suggested meningeal symptoms of impairment, meningeal irritation Levy said. Cause pathogenesis headache, vomiting due to the occurrence of the meninges of the trigeminal nerve and vagal sensory devices by the end inflammatory and mechanical stimulation. Tonic neck is disclaimer neck muscles cervical plexus by inflammation, physico-chemical changes induced stimulation of muscle cramps and neck pain associated with induced. And the positive Klinefelter Syndrome, brucellosis levy were due to the corresponding disposable nerve roots caused by the stimulation. Causes can be divided into infectious, non-infectious factor of two. The former is mainly bacteria, viruses, fungi spirochetes, parasites and other pathogens cause encephalitis and meningitis. The latter is mainly subarachnoid hemorrhage, brain tumors, rheumatism and leukemia and certain diseases of meningeal disease outside influence. A clinical performance. Headache, vomiting : often intense headache is the most common symptoms, course there will be early. Generally diffuse and sometimes occipital and frontal particularly notable. Vomiting was more of projectile. 2. Neck muscle rigidity : tough on the neck muscles passive resistance movement, such as passive neck flexion were spasm and pain. 3. Klinefelter Syndrome : lower limb hip, knee flexion at right angles, then make leg extension, the normal extension can be reached above 135 °, In case of resistance, and less than 135 ° when Cox was hurt. 4. Brinell levy : suppression in patients lying, neck flexion movement, two automatic leg buckling positive for the cerebellum meningeal irritation. Another skin hypersensitivity, visual and auditory stimulation, such as allergies. A differential diagnosis. Bacterial infections (1) meningococcal meningitis (meningococcal meningiti s) in winter and spring fashion, rapid onset, illness sinister, displaying signs of meningeal irritation Notable : severe headache, vomiting (was jet-like) and strong neck with Occipitocervical Department, spinal pain, Clinton's levy, the levy will Brinell strong positive, audio-visual hypersensitivity. But in a period of pop "blunt-down," meningeal irritation little, slightly low heat, fatigue and back pain. Most CSF was pus-like opacity, the amount of cells can be very high (in 1.0 × 109 / L and above). Categories with the neutral-leaf nuclear dominance, protein, sugar and chloride decreased noticeably. Skin bleeding and cerebrospinal fluid can be found meningococcus. (2) of tuberculous meningitis (tuberoublor meningitis) more common in children, more gradual onset, can be quite radical polymerization, in addition to clinical symptoms of fever, chills, headache, general poisoning symptoms, all signs appeared to the earliest tough neck muscle, is an early diagnosis. CSF has been changed at this time : most of the pressure increased, clarification, colorless, or slightly polluted and ground glass-like, Still often after forming a thin film. In general cells increased 0.05 ~ 0.5 × 109 / L, lymphocytes dominant classification, reducing sugar and chloride. (Less than 1.96 mmol / L and 119mmd / L) were found in cerebrospinal fluid can be diagnosed tuberculosis. Also available PCR-DNA-Tb diagnosed. (3) Pseudomonas aeruginosa meningitis (pryocyanic meningitis) Clinical rare. In addition to the performance of acute purulent meningitis patients with disease progression as a gentler, the most characteristic change is the cerebrospinal fluid was green and yellow, The depth of color often with the severity of symptoms, the number of cells was proportional. CSF culture for bacteria. (4) pneumococcal meningitis (Pneumococcal meningitis) often secondary to lung Yan, otitis media and other diseases, multiple winter and spring, was particularly prevalent in the less than 2-year-old and the elderly, and the clinical sense obstacles, cranial nerve damage, intracranial hypertension and meningeal irritation. Concurrency can hydrocephalus, brain abscess, such as hemiplegia aphasia. Peripheral blood leukocytes was significantly higher neutrophil most of the more than 95%. CSF was purulent, cells and protein content, sugar and the reduction of chloride. Advanced Spinal patients may have obstructive cell protein separation. (5) influenzae meningitis (influenal meningitis) from the majority group influenza b bacillus caused six months-three-year-old styles, a good autumn, some of upper respiratory tract infection or bronchial pneumonia precursor history. Other than the onset purulent meningitis slightly alleviate the initial still have respiratory symptoms, the baby can be seen Hang doors prominent, beneath the skin and mucous point rare, the main basis for the diagnosis of smear and culture positive. (6) Brucella meningitis (brucellar meningitis) can develop fever and headache. vomiting, positive Klinefelter Syndrome and other meningeal irritation, and the majority of cranial nerve (II, V, VI, vii) damage symptoms. CSF pressure increased. Appearance clarification or mildly stuffy, - pus was opacities. Cell number, classification of the majority of mononucleosis. Protein increased in 1.0 / L and above, the reduction of sugar, chloride normal or slightly lower. CSF agglutination and complement with more positive tests, culture or animal species can be seen Guitar brucellosis. (7) meningitis Bacillus anthracis (anthrax bacillus meningitis) may be cited with meningeal irritation and bleeding meningeal inflammation. CSF was gutsy, pressure increased protein and cell count increased significantly, sugar was reduced significantly, Smear and culture can be found a large quantity of Gram-positive bacilli large, square ends were, as linked chain. (8) Other bacterial meningitis caused by Enterobacter cloacae in meningeal more common in premature rupture of amniotic membrane, birth injuries and premature newborns. In a general post-natal ~ 2 weeks of onset. Clinical manifestations of feeding, and Aeromonas condemnation, fidgety feet, two staring, convulsions, respiratory difficulties. Staphylococcus aureus meningitis accompanied purulent skin infections. In some cases the disease early will have scarlet fever rash or urticaria. 2. infection (1) Japanese Encephalitis (JE encephalitis B) JE virus. more ~ September 7 in rapid-onset. High fever, convulsions or coma, 70 ~ 80%, there will be the meningeal irritation, increased muscle tone, brisk tendon reflexes and pathological reflex positives. CSF propeller was aseptic liquid effusions : transparent colorless or slightly mixed, normal pressure or shoot high, WBC, Most of the 0.05 ~ 0.5 × 109 / L between, and occasionally up to a 109 × / L or more. Categories mainly lymphocytes, normal or high sugar, protein increased slightly, Chloride normal. JE monoclonal antibody passive hemagglutination inhibition test (RPHI) diagnosis, the positive rate was 85%. (2) Lymphocytic Choriomeningitis (Hodgkins chorimeningitis ) history of exposure to rodents, winter and spring styles and distributed. Clinical typical case of double heat. No. 1 headache accompanied by fever peaks with acute upper respiratory symptoms, sustained a few days to several days. ~ by a majority of two days or longer in remission, and then the emergence of a second hot peak, and there meningeal irritation. CSF change : pressure normal or mildly elevated, normal appearance, a few slightly stale, cells normally 0.1 ~ 1.5 × 109 / L between lymphocytes of 80 ~ 100%. protein content, sugar and chloride normal, a few cases of cerebrospinal fluid static after the film formation, Acute virus isolation results will be positive. (3) mumps virus meningitis (mumps meningitis) generally occurred in the victim's parotid after. Was mostly male children. Mainly fever, loss of appetite, nausea and vomiting, a significant headache, drowsiness or semi-conscious state. Serious illness can arise stupor and body convulsion, meningeal irritation is very obvious, while Mydriasis. Both sides often asymmetrical. Also often the phenomenon of terror and allergies. CSF pressure increased, colorless and transparent, increased cell number hundreds of thousands, lymphocyte absolute advantage, protein increased slightly. 90% of patients with elevated urinary amylase, complement fixation test, hemagglutination inhibition test in the diagnosis. (4) rubella meningoencephalitis (rubella meningocephalitis) from rubella disease lead poisoning, in general rash after a seven-day occurrence. Poly attacks or gradual, often fever, headache, sore throat, nausea, vomiting, lethargy, meningeal excited levy. At worst, there will be convulsion, coma and even paralysis of limbs all symptoms. CSF leukocyte counts increased in the early neutrophils high, the late lymphocyte predominant. Protein normal or mildly elevated, sugar normal. Virus isolation and coagulation inhibition, and test-binding test will be positive results. (5) Herpes simplex encephalitis (herpes simplex encephalitis) non-pop encephalitis in the most common type. Many violations of children and youth, a more serious condition. Prior to the onset lips, buccal mucosa and genitalia with a blister, general by 6 ~ 10 days there encephalitis symptoms : headache, vomiting, fever, mental disorder, and the obvious symptoms of meningeal irritation, systemic twitch, accompanied local stoves symptoms : hemiplegia, aphasia, and cranial nerve damage, seizures, ranging from both sides of the pupil, sometimes cerebral palsy. CSF pressure increased, cells increased up to 0.1 ~ 0.5 × 109 / L. Categories lymphocytes advantage. There will be a large number of red blood cells, usually in 0.5 × 109 within. Advanced will have yellowing. CSF herpes simplex virus antibody-positive or PCR-DNA-positive HSV can be diagnosed. (6) herpes zoster encephalitis (zaster encephalitis) was particularly prevalent in the elderly. Infected with varicella-zoster virus, before a rash often unwell, 3 ~ 4 days after herpes, In the first trunk and limbs, facial different location, or along a few of the nerve root on zonal distribution, or back pain was burning. 6% associated with encephalitis, diffuse lesions were generally manifested as headache, vomiting, fever, mental disorder, disturbance of consciousness. Some appeared side limb paralysis, cranial nerve palsy, and other symptoms. Can apparently symptoms of meningeal irritation. CSF normal appearance. Lymphocytes noticeably increased, and mildly elevated protein. CSF varicella-zoster virus antibody positive, complement fixation test positive can be diagnosed. (7) Huai encephalomyelitis chickenpox (varicella cerebrospinal meningi Métis) is common in children with more fat in the winter and spring. Before the onset of a mild headache, nausea, limb pain, fever, epistaxis, fever within 24 hours after the rash, as spotted early. A few hours later to papules to herpes. Three days to two weeks inside encephalomyelitis : vomiting, convulsions, delirium and stupor, and so on. Obviously meningeal irritation symptoms after a few hours or a day, patients can get back to consciousness, then there will be the brain, cerebellum and spinal cord damage symptoms. CSF colorless and transparent, pressure can be increased slightly, lymphocytes can be increased slightly, and higher protein. (8) Forest encephalitis (encephalitis forest spring) as special forest areas Some of acute infectious diseases. More patients in the history of tick bite, usually a sudden onset. Were high fever, headache, nausea, vomiting, coma or consciousness, and rapidly emerging meningeal irritation. Flaccid paralysis is the main feature of the disease, the diagnosis meaningful. CSF pressure normal or slightly higher, colorless and transparent, mild increase in protein, sugar and normal chloride, cells in a number of 0.05 ~ 0.2 × 109 / L between the classification lymphocytes dominant, Serological screening with the "polio", "JE" differential phase. (9) infectious mononucleosis disease (infections mononucleosis syn drom) may be caused by a virus. Clinical offerings for its irregular fever, laryngitis, swollen lymph nodes, spleen, blood lymphocytes increased and abnormal, and a serum lectin Aeromonas heterosexual. The disease process may appear meningeal disease Yan and encephalomyelitis. The former may have dizziness, diplopia, meningeal irritation positive, lethargy, mental disorder, which may eventually was unconscious, brain tonic to the levy, Bilateral Pap patients. CSF pressure increased, leukocytosis, lymphocytes accounted for the majority, with moderately high protein levels. Aeromonas serum lectin variant reaction by the guinea pig kidney adsorption after titration titer in a : 64 and above can be diagnosed. (10) A case of Mollaret's meningitis (Mollare's meningitis) is a Minute fat of aseptic meningitis, cause that might be infected. The clinical manifestations of mild meningitis, the tendency to relapse. Laboratory examination period is characterized by seizures, cerebrospinal fluid, there will be a large number of sub-leaf cells and granulocyte monocyte, and the tremendous fragile "endothelial cells." CSF glucose level was reduced to moderate and mild globulin increased. Attack every two-three days may ease. Patients in remission health restored, but the blood leukocyte reduction and mild eosinophilia tendency serum IgM were moderately higher. (11) sporadic encephalitis (sporamdic encephalitis), including actual brain virus Yan and viral infection caused by acute demyelination encephalopathy two categories, the majority were acute or subacute onset. half of patients with the disease before 1 ~ 4 weeks with upper respiratory or gastrointestinal tract infection symptoms and signs, mainly extensive damage to the brain's performance, almost all the brain damage nerve symptoms may clinical manifestations of this disease. According to the main features, clinical type can be divided into a coma, brain tumor type, epilepsy and mental disorder-type four types. Often damaged to varying degrees autonomic symptoms, the performance of sweat dripping or central heating, and so on. There will be a small number of patients Brinell levy, Clinton levy positives meningeal irritation. Post laboratory tests can increase peripheral blood leukocytes, neutrophils increased, a number of cases increased brain pressure ridge, cells in 0.1 ~ 109 / L%, mainly lymphocytes. Most protein IgG and slightly elevated chloride and sugar normal. EEG 80 -90% of patients with diffuse abnormalities, or changes in diffuse emerged on the basis of focal frontal temporal change. CT showed bilateral cerebral hemisphere scattered unclear lines of low-density, contrast agent is not enhanced. Cranial MRI bilateral hemispheres scattered high signal area, and not connected ventricle. (12) AIDS (acquired immunodficiency syndrome. AIDS) 40% ~ 50% of adults and 70% ~ 80% of children with nervous system dysfunction, Pathogen of their human immunodeficiency virus (HIV) infection directly nervous system, Primary meningitis caused acute and chronic meningitis. The former manifestations of acute psychiatric symptoms, disturbance of consciousness meningeal irritation, often associated with grand mal epilepsy. Acute symptoms may disappear in a few weeks. The latter mainly for chronic headache and meningeal irritation, involving V, VII, VIII right brain. Immunosuppression secondary to the nerve system damage the central nervous system viruses, bacteria, fungi infections, Toxoplasmosis brain and central nervous system lymphoma. It can be seen in cerebral hemorrhage and subarachnoid hemorrhage and other complications. Appeared meningeal irritation and other related clinical manifestations. Immune examination showed decreased blood lymphocytes, in vivo delayed allergic weakened or disappeared, In vitro cytotoxic response decreases or disappears, the mother cell conversion decreases or disappears, serum IgG, IgM, IgA often increase, B2-microglobulin, serological test can detect HIV antibodies positive, CSF formed inflammatory changes, EEG examination showed diffuse abnormal. 3. spirochetes and Rickettsia infection (1) Leptospirosis meningitis (leptospiral mening itis) of the recent history of exposure to infected water, in addition to the acute phase of fever, chills, weakness, facial and integration of congestive film, gastrocnemius muscle tenderness, and other systemic symptoms, often severe headache, vomiting, irritability, feelings of allergy. Weight may be disoriented, and delirium, convulsion, paralysis of limbs, the increased intracranial pressure and other symptoms of encephalitis. A few days after the disease emerged in meningeal irritation. With the course of cerebrospinal fluid pressure can be increased. To mononucleosis mainly of cells increased. Protein mildly higher. Sugar and normal chloride, 80% of patients around blood neutrophils increased. Leptospirosis serum and cerebrospinal fluid-binding tests and coagulation tests were positive acute phase of pathogens isolated in cerebrospinal fluid. (2) meningovascular-mei (meningovascular syphilis), most onset Implicit attack, the course may be urgent relief to the bottom of chronic cerebral meningitis owners, common symptoms are headache, mental retardation, cranial nerve palsy, Partial epilepsy, the impact of cerebrospinal fluid circulation to be increased intracranial pressure, hydrocephalus. Cerebral arteritis dominant, can be in the form of ischemic stroke. Visibility involving the hypothalamus polyuria and lethargy, obesity and other endocrine and metabolic disorders performance. Course there can be meningeal irritation. CSF common to lymphocytes mainly by the increased leukocyte, quantitative normal sugar, protein and total r globulin increased. Apart from Fahrenheit serum response and the positive reaction of Coons, Treponema pallidum fluorescent antibody assay (FTA-ABS) positive and specificity, It is the most commonly used method. (3) relapsing fever spirochetes meningitis (spirochaeta recurrentic meni ngitis) clinical cyclical fever, severe headache, severe joint and body skeletal muscle pain, hepatosplenomegaly, jaundice, bleeding tendency to feature. Patients will have serious coma, delirium, convulsion and meningeal irritation. CSF pressure can be slightly higher. And lymphocyte protein slightly increased, and some may BCSF. Found in the cerebrospinal fluid can be diagnosed spirochetes. (4) Lyme disease is by Burg Frei reduced by spirochetes spleen systemic spread of infectious diseases. 11 ~ 14% in patients with damage to the nervous system, lymphocytic meningitis and meningoencephalitis most common, The main symptoms are headache, with intense when nausea, vomiting, photophobia and ocular pain activities, the temperature is not high. Signs of a neck stiffness, but Clinton's levy and the levy were negative brucellosis. CSF significantly increased inspection lymphocytes, protein increased brain pressure and sugar normal, Lyme disease antibodies. CSF isolated pathogens up to 10%. (5) typhus epidemic meningitis (epidemie typhic meningocep halitis) in the disease spread by ticks Rickettsia prowazekii body acute infectious disease caused by the invasion of the central nervous system at any time now. Patients can onset of delirium state, serious cases of fever or recovery period, there will be stupor and coma. meningeal irritation is obvious, intracranial pressure can be increased but no abnormal CSF general. Some cases of mononucleosis and protein slightly increased. Fair with various other nervous system damage locust focal symptoms : hemiplegia, aphasia, the blind and paraplegic, neuritis, and psychiatric symptoms. The disease is the pathological changes of vascular damage of endothelial cells. Determination of several foreign Pei's reaction, the reaction can be as positive diagnosis. 4. Fungal infections (1) cryptococcal meningitis (crypeococcus meningitis) The disease is often hidden ball sepsis part of the brain gray granuloma formation of nodules, resulting in diffuse meningitis. The clinical manifestations of fever, headache, nausea and vomiting mainly associated with mental disorder and meningeal irritation can also be associated with aphasia, hemiplegia, Focal ataxia, and other symptoms. Have increased intracranial pressure, palilledema, tendon hyperreflexia, such as pathological reflex. Slow disease progression, similar to tuberculous meningitis. CSF said : pressure increased, the normal appearance, increased protein, cells from the normal 0.3 to ~ 0.5 × 109 / L range. The main lymphocytes. Sugar can be reduced significantly to zero, to reduce chloride can be found high concentrations of ethanol. The inspection using membrane CSF, with MGG stain, cryptococcal positive detection rate of 84 ~ 100%. (2) Candida albicans meningitis and nocardiosis meningitis (Candida albicans men ingitis and nocardial meningitis) are the two corresponding meningitis The fungi cause. Clinical symptoms and cerebrospinal fluid changes are similar to cryptococcal meningitis, is accepted by meningeal irritation symptoms. Identification mainly rely on CSF fungal culture. (3) actinomycosis meningoencephalitis (actinomy cotic meningocepholit is) in the body Actinomycosis invasion of the central nervous system occurred. Can cause purulent released from uveitis, brain abscess, caused obvious meningeal irritation and headache symptoms. These symptoms sustainable weeks. Or even months, gradually worsened. Final submissions to stupor or coma. CSF pressure can be increased. Leukocytosis or even hundreds of thousands, ~ 70% to 80% neutrophils. CSF found fungi can be diagnosed. (4) aspergillosis meningitis (Aspergillus meningitis) in the disease aspergillosis invasion guilty of the central nervous system occurred. Aspergillosis by Qu genus of bacteria caused by a granulomatous inflammatory damage that may lead to skin, eyes and bronchial, lung, multiple bone damage in the brain and the meninges, the cause meningitis, brain abscess, brain and subarachnoid hemorrhage. No specific clinical features, more and tuberculous meningitis, brain abscesses and brain tumors with similar concern. Meningeal irritation can occur and the levy Babinski's levy positive, but also a focal cerebral cranial nerve damage levy. CSF pressure increased, colorless and transparent, cell number increased to 0.1 ~ 0.5 × 109 / L around, Neutrophils mainly protein increase. CSF found a small park-shaped spores and hyphae of the sub-section can be diagnosed. 五、parasitic brain disease (1) of cerebral malaria (cerebral malaria) in the malignant malaria incidence about 20% of children with access to new non-endemic areas of malaria-prone areas crowd. Delirium and coma as the main symptoms of the brain. Patients at the onset of severe headache, convulsion, such hiccup. A few patients may have irritability, mania and other psychological symptoms. Meningeal irritation symptoms, paralysis, aphasia, pyramidal tract levy was less than 20%. Most patients with high fever or hypothermia. CSF pressure can be increased, but the number of cells and biochemical components have no abnormalities. Peripheral blood leukocytes few majority reduced smear Plasmodium easy to find. (2) cerebral schistosomiasis (cerebral bilharziaisis) of the disease in Schistosoma japonicum infection invading the central nervous system there. A history of exposure to infected water, the more the incubation period after infection for about six months. The main clinical manifestations of diffuse brain inflammation : drowsiness or coma, orientation obstacles, incontinent, paralysis, convulsions, Cone beam levy and meningeal irritation symptoms. In addition, heating and eosinophil increased systemic symptoms. Some patients may have auditory hallucinations, implicated concepts, paranoia, insight and judgment, such as the lack of psychiatric symptoms. Therefore, with the symptoms of acute encephalitis or acute psychiatric symptoms in patients with early as schistosomiasis infection, Antimony cured by the agent who will be diagnosed. So put in the way of CT and MRI to determine the lesion location, and observation and dynamic change. Schistosoma stool examination including precipitation, incubators and serum COPT reaction, freeze-dried blood indirect hemagglutination test. Enzyme-linked immunosorbent assay, polyethylene glycol precipitation test, monoclonal antibodies against the original test and skin test. CSF ELISA test can identify other causes of myelitis. (3) paragonimiasis encephalopathy (cerebral paragonimiasis) type of meningitis more common in patients Early way. Performance of severe headache, vomiting, fever, disturbance of consciousness, increased intracranial pressure and symptoms of meningeal irritation. History of patients infected areas, migratory subcutaneous nodules or lung symptoms, increased CSF pressure, a large number of eosinophil. protein may also increase. Immune serum and cerebrospinal fluid test was positive. Anti-paragonimiasis pilot treatment produce. (4) brain cysticercosis (cerebral cysticercasis) clinical symptoms by parasitic cysticercosis location varies. Epileptic seizures can occur, the increased intracranial pressure, motor and sensory disorders and cerebellar ataxia and mental symptoms. Cysticercosis parasitic brain in the bottom, meningitis can lead to chronic changes in subcutaneous and intramuscular nodules can cysticercosis, CSF pressure cells, sugar and protein can be increased, eosinophils, blood or CSFIT (IHA, ELISA) will be positive results, CT, MRI can change the image of neurocysticercosis. (5) filariasis (filariasis) brain, there may be violations of infarction, meningoencephalitis syndrome. and meningeal irritation symptoms. Patients infected areas living history and systemic clinical manifestations of filariasis, blood eosinophil higher Intradermal test antigen-binding and the trial will help the diagnosis. Skin, blood, cerebrospinal fluid were detected in adult or bancrofti. (6) amoeba encephalopathy (Memorial encephalopathy) Acanthamoeba trophozoites can Hematogenous the human brain, in terms formed multiple small lesions or pyogenic brain abscess, hemorrhage and can be softened, performance of the intracranial space-occupying lesion or lesions Xu meningitis appeared meningeal irritation symptoms, Other clinical organ amoeba infections performance can be found in cerebrospinal fluid protozoa. Primary amebic meningoencephalitis performance for the TV headache, fever, rhinitis, temporal lobe symptoms and disturbance of consciousness, meningeal irritation. CSF was purulent or bloody, you can often find a parasite inoculation training will be positive results. (7) roundworm encephalopathy (ascaris encephalopathy) roundworm larva to be transitional caused brain central nervous system damage, but also from the roundworm secretes the toxin role in brain damage, headache, dizziness, insomnia, irritability, epilepsy, and meningeal irritation. Pai more patients, the history of the Turpan - roundworm, Ascaris suum Egg a stool examination, blood eosinophils leukocytosis. 6. Non-infectious diseases (1) subarachnoid hemorrhage (subrachnoid hemorrhage) more from aneurysms and vascular malformations, hypertension and other vascular diseases arteriosclerosis and can also be caused by leukemia, purpura, liver disease caused. Vascular rupture after subarachnoid blood flow, cerebral cortical edema, ischemic damage occurred plaque, but also have vasospasm, increased edema and cerebral ischemia. Clinical manifestations onset general rush to begin intense headache, immediately lapsed into a coma, or only see a headache and mental sluggish but not a deep coma. Other fair with high fever, chills, vomiting, unstable blood pressure and other symptoms. 60% more patients meningeal irritation. Case in the first few hours or even 24-hour period, although severe bleeding, but not painful contracture, Klinefelter Syndrome not obvious. After the onset of a few hours or days will be bloody lumbar puncture or short BCSF, after placing no solidification, specimens placed slightly longer erythrocyte sedimentation, floating liquid ah-transparent color, or microstrip yellow protein increased. (2) brain tumors (cerebroma) general cause increased intracranial pressure and focal damage symptoms. On certain cancers such as tumors, brain metastases, posterior fossa tumor, there will be the meningeal irritation. similar to the symptoms of meningitis may not obvious. CSF investigation may see the tumor cells or showed courage, but meningeal metastases can be expressed as the cerebrospinal fluid cell count increased and protein increased. CSF bacterial growth custody and cytology contribute to the diagnosis. (3) rheumatic meningoencephalitis (rheumatic meningocepholitis) of the disease Rheumatic heart disease often on the basis of gradual, headache, lethargy, malaise, delirium, often wet body increased and visible symptoms of meningeal irritation. CSF cells and protein can be increased. Pathological examination revealed exudative and proliferative diseases, accompanied by meningeal and cerebral hemorrhage. In addition, rheumatic cerebral hemorrhage and other causes of cerebral bleeding, can occur disturbance of consciousness, hemiplegia, BCSF and meningeal irritation. (4) increase in eosinophil meningitis (eocinophilic meningitis) is more parasites such as (swine cysticercosis, roundworm) infection direct invasion of the central nervous system caused by allergic reactions or cause. Course there can be meningeal irritation. CSF leukocytosis, eosinophil cells. (5) type of meningitis leukemia (AML meningitic) is the type of leukemia cells arachnoid induced infiltration may also bleeding. Common in children with acute lymphoblastic leukemia in remission. Clinical features of intracranial hypertension and meningeal irritation, cranial nerve damage, paraplegia, hemiplegia, convulsion may also arise. Brain scan showed pressure ridge higher protein content increased, cell number, reduced sugar, or courage, and culture-negative bacteria, and leukemia cells with meningitis are different. (6) meningeal cerebral Yan-Behcet's Disease (meningocephalitic Behcet'di ease) in Behcet's Disease can occur when the headache, recurring paralysis paraplegia with its characteristics, in the course of which there will be the meningeal irritation symptoms had a brain spinal cord multiple sclerosis. (7) heat stroke (heliosis) heat stroke can result cerebral vasomotor obstacles meningeal stimulation, occurred meningeal irritation symptoms and headache, vomiting, irritability, disturbance of consciousness, coma, and the emergence of Jimmy levy. Cerebrospinal fluid examination in addition to increased pressure, could not protein and cell reaction, if sustained over a long duration. Visibility multinucleated cells and monocytes have increased slightly, but not sugar and chloride changes. (8) uremia (uremia) in uremia can headache (with uremia are unrelated to the main blood pressure) and meningeal irritation. CSF pressure can be increased, sometimes very pale yellow color and lymphocytes increased protein increased slightly, This might be related to renal failure in the quality of the bleeding. (9) ketone hyperlipidemia and diabetes (diabetes and ketonemia) children and youth ketone hyperlipidemia or acute diabetic coma, severe meningeal irritation : Tonic neck, the positive Klinefelter Syndrome were very obvious, can be accompanied by increased body temperature, a CSF monocyte response protein increased slightly. This need with tuberculous meningitis differential. (10) liver disease (hepatopathy) in severe acute jaundice hepatitis, liver cirrhosis patients with severe liver dysfunction and liver coma, clinical Visibility meningeal irritation. This may be liver disease and metabolic disorders resulting peptide toxic substances into the cerebrospinal fluid, and hepatic coma can be caused by the brain edema. Clinical manifestations : Tonic neck, legs often buckling, Klinefelter Syndrome positives. Delirium can be, physically shook, the tendon reverse hyperthyroidism, paresthesia, and other symptoms. CSF conventional and biochemical abnormalities without inspection, but the peptide content. (11) lead poisoning encephalopathy (ledd encephalopdtyy) at the central nervous system of lead poisoning different types of pathological changes, not exactly the same mechanism. Induced hypertension or artery lesions caused by the brain softening, with meningeal and have no pathological brain changes appeared individually meningeal pathological reaction. Lead poisoning meningeal irritation sometimes dramatic performance of severe headache, nausea, vomiting, neck stiffness and seizures, delirium, stupor and coma. Lead poisoning sometimes tend to ease abdominal pain, and symptoms of meningeal irritation anti-emerge. CSF said pressure increased significantly higher protein, protein more quantitative 0.4 ~ 1.0 / L, increased cell number, Categories mainly lymphocytes, sugar and chloride no significant changes. (12) other allergic diseases of certain diseases can occur meningeal irritation. CSF can be mild lymphocyte reaction, the normal protein. Cerebral cortex can be softened with meningeal irritation symptoms. Meningeal irritation symptoms, cerebrospinal fluid multinucleated cells prominent reaction. Stimulate foreign bodies, such as cerebral angiography gas gas injection, the JOLECTTHIN lipiodol contrast injection can cause meningeal irritation, clinical manifestations headache, neck stiffness, Clinton's positive sign. CSF cells show increased 0.01 ~ 1 × 109 / L ranges, protein 1.0 mmol / L and above. generally available in a few days to resume.