Neurology · MU Sofia

34. Meningeal syndrome, increased intracranial pressure syndrome, idiopathic intracranial hypertension

Covers meningeal syndrome, including its causes, the general symptoms, the Kernig and Brudzinski signs and typical CSF changes. It then goes through raised intracranial pressure, with the Monro–Kellie reasoning, early and late signs, Cushing triad, papilledema and herniation syndromes. The final part addresses idiopathic intracranial hypertension: risk factors, clinical features, examination, imaging and lumbar puncture findings, and treatment options. A diagram accompanies the meningeal section.

Inside: 1 section · 1 labelled picture · 16 flashcards · 2 min

Topic 34 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 301 words (2 min of reading), with 16 flashcards.

In this note

  1. Menigneal syndrome. Syndrome of increased intracranial pressure. Idiopathic intracranial hypertension

Menigneal syndrome. Syndrome of increased intracranial pressure. Idiopathic intracranial hypertension

1. Meningeal Syndrome

Definition: A clinical syndrome caused by irritation of the meninges (pia, arachnoid, dura) due to infection, hemorrhage, or inflammation.

Main Causes: Meningitis (bacterial, viral, TB). Subarachnoid hemorrhage. Tumors / carcinomatosis. Drugs / toxins (rare)

Clinical Features

  • General Symptoms: Severe headache. Fever (usually in infection). Vomiting (often without nausea). Photophobia. Malaise
  • Meningeal Signs: Neck stiffness (nuchal rigidity). Positive Kernig sign. Positive Brudzinski sign
  • Kernig Sign: Pain and resistance when extending the knee with hip flexed.
  • Brudzinski Sign: Involuntary hip/knee flexion when neck is flexed.

CSF Changes (important link): ↑ cells (pleocytosis). ↑ protein. ↓ glucose (bacterial/TB meningitis)

2. Increased Intracranial Pressure (ICP) Syndrome

Definition

  • Increase in pressure inside the skull due to: Brain tissue. Blood. CSF
  • Normal ICP ≈ 5–15 mmHg

Causes (Monro–Kellie doctrine)

Skull contains: Brain tissue. Blood. CSF

Increase in one → compensation fails → ICP rises

  • Causes: Brain tumors. Hemorrhage. Hydrocephalus. Trauma. Cerebral edema. Infection

Clinical Features: Early Signs. Headache (worse in morning). Vomiting (projectile). Blurred vision. Papilledema

Later Signs (dangerous): Decreased consciousness. Bradycardia + hypertension (Cushing reflex). Irregular respiration. Pupillary abnormalities

Cushing Triad: Hypertension. Bradycardia. Irregular breathing

Papilledema: Swollen optic disc. Visual blurring. Enlarged blind spot

Herniation Syndromes (key exam point)

  • Uncal herniation → CN III palsy, pupil dilation
  • Tonsillar herniation → respiratory arrest

3. Idiopathic Intracranial Hypertension (IIH)

Definition: Raised ICP without a structural brain lesion or hydrocephalus.

  • Also called pseudotumor cerebri.

Risk Factors: Young obese women (most common). Vitamin A excess. Tetracyclines. Steroid withdrawal

Clinical Features: Chronic headache. Transient visual obscurations. Pulsatile tinnitus. Diplopia (VI nerve palsy). Papilledema (key sign)

Neurological Exam

  • Usually normal except: Papilledema. Possible abducens nerve palsy (CN VI)

Diagnosis

  • Imaging (MRI/CT): Normal brain. No mass lesion
  • Lumbar Puncture: ↑ opening pressure. Normal CSF composition

Treatment

  • Weight loss
  • Acetazolamide (reduces CSF production)
  • Repeated lumbar puncture (temporary)
  • Surgical: shunt if severe

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