Acute Leptomeningitis.

Synonym.—Acute Spinal Meningitis.

Definition.—Leptomeningitis is an inflammation of the pia mater, and may be acute or chronic.

Etiology.—The exciting cause is not positively known, though it is now generally accepted as being due to infection from pyogenic cocci, the most frequently seen being the pneumococcus, the meningococcus following next.

Exposure to wet and cold, as well as direct or indirect injury to the spinal column, such as fractures, wounds, or surgical operations, has been followed by meningitis, though these may have been only preparatory means for the entrance of the infecting' bacteria.

It is often associated with tuberculosis and the infectious fevers, particularly croupous pneumonia, typhoid fever, scarlet fever, diphtheria, pyemia, and septicemia. It may also be due to an extension of inflammation of the meninges of the brain.

Pathology.—The changes in the membranes of the cord are those peculiar to inflammation. First, hyperemia, which may be diffused throughout the length of the cord or localized. This is followed by, an exudation of fibrinous material containing red blood-curpuscles and leukocytes, which later changes to pus. The nerve-roots may also be involved. Owing to the dorsal position assumed, the exudate is more profuse on the posterior portions of the pia mater, due to gravitation. Similar lesions are found in the cerebral meninges, in the majority of cases.

Symptoms.—The disease generally begins with a well-marked chill followed by febrile reaction, which early may assume a septic type. Where the cerebral meninges are involved, the early symptoms, flushed face, bright eyes, contracted pupils, and restless condition, may for a time obscure the main lesion. Soon, however, the intense pain in the cervical region, the marked hy-peresthesia, and the tonic or clonic spasm of the muscles drawing the head backwards, removes all doubt as to the seat of the lesion.

There is marked tenderness along the spine, and when the spasms are intense there may be opisthotonos. There may be retention of urine, due to reflex spasm of the bladder. The reflexes are all exaggerated.

As the acute inflammation subsides, anesthesia replaces the hyperesthesia, paralysis follows, and the reflexes disappear.

Diagnosis.—The diagnosis should not be difficult. The tenderness along the cervical region, the intense pain in the back, radiating to the upper and lower extremities, retraction of the head, hyperesthesia, rigidity of the muscles, and fever of a septic type, can not be mistaken for any other lesion.

Prognosis.—This is a grave lesion, and the prognosis must be guarded. Death may result in forty-eight hours, or be prolonged for two or three weeks.

Treatment.—Aconite in the small dose, and gelsemium and echinacea in full doses, will form a good treatment, thus:

Sig. Teaspoonful every hour.

Rhus tox., macrotys, and bryonia should be given as may be indicated, and the sulphites, chlorates, and mineral acids where sepsis -indicates their use. Great care must be exercised during convalescence, that the patient avoid everything that tends to excitation.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.