Clinical Predictors for diagnosis of central nervous system (CNS) infectious diseases

The purpose of our study was to assess the reliability of meningeal signs and other physical findings in predicting central nervous system (CNS) infectious diseases.
Using some clinical indicators we performed lumbar puncture in 224 patients who were suspected to have CNS infections, and had at least one these indicators. These signs, bulging and/or pulsating fontanel, meningeal irritation signs (MIB) fever of unknown origin (FUO) hedache-vomiting, suspicious rash and irritability.
135 of 224 lumbar punctures were positive for pleocytosis. The indidence of each clinical indicator for LP according to age groups of 135 patients were evaluated.
The signs and symptoms mostly present in patients less than 2 yrs of age were neurological signs, fontanel signs and fever of unkown origin and over 2 yrs of age were headache-vomiting meningeal irritation sign and FUO. Convulsion were present more in the under 2 yrs of age group.
We would suggest that a patient less than 2 yrs of age presenting with only FUO, convulsions or neurological signs, and a child over 2 yrs of age presenting only headache-vomiting or FUO and all children presenting with only suspicious rash or irritability although not having the classical signs of CNS infections such as MIB but only have bulging fontanel must be performed a lumber puncture.

MSS ENFEKSİYONLARININ TANISINDA KLİNİK PREDİKTÖRLER

Çalýşmamýzýn amacý MSS enfeksiyon hastalýklarýnýn tanýsýnda meningeal ve diğer fiziksel bulgularýn önemini araştýrmaktý.
MSS enfeksiyonu şüphesi ile başvuran 224 hastada bazý klinik indikatörleri kullanarak, bunlarýn en az birine sahip olan her hastaya lomber ponksiyon (LP) uyguladýk. Kullanýlan klinik indikatörler, konvülsiyon, nörolojik bulgular, fontanelin bombe ve/veya pulsatil olmasý, meningeal irritasyon bulgularý (MiB), nedeni
bulunamayan ateş, baş ağrýsý-kusma, şüpheli döküntü ve irritabilite idi.
224 hastanýn 135'ine MSS enfeksiyonu tanýsý kondu ve yaş gruplarýna göre herbir indikatörün görülme sýklýğý incelendi.
2 yaþýýn altýndaki çocuklarda en sýk nörolojik bulgular, nedeni bulunamayan ateş ve fontanel bulgularý saptandý.
Konvülsiyonda bu yaş grubunda daha büyük çocuklara oranla daha sýk görüldü. 2 yaşýndan büyük çocuklarda ise en önemli bulgular baş ağrýsý, kusma, MIB ve nedeni bulunamayan ateş idi. MiB ve fontanel bulgularý olmasa
dahi 2 yaşýndan küçük çocukta tek başýna nedeni bulunamayan ateş, konvülsiyon veya nörolojik bulgu varlýðýnda ve 2 yaþýndan büyük çocukta tek baþýna baþağrýsý, kusma veya ateş varlýğýnda ve tüm çocuklarda tek baþýna þüpheli döküntü veya irritabilite varlýðýnda LP uygulamak gerektiği kanýsýna varýldý.