Meningitis is an inflammation of the membranes (meninges) and cerebrospinal fluid surrounding your brain and spinal cord, usually due to the spread of an infection. The swelling associated with meningitis often triggers the “hallmark” symptoms of this condition, including headache, fever and a stiff neck.

Many of the bacteria and viruses that cause meningitis are fairly common and are typically associated with other routine illnesses. Bacteria and viruses that infect the skin, urinary system, gastrointestinal or respiratory tract can spread by the bloodstream to the meninges through cerebrospinal fluid, the fluid that circulates in and around the spinal cord.

In some cases of bacterial meningitis, the bacteria spread to the meninges from a severe head trauma or a severe local infection, such as a serious ear infection (otitis media) or nasal sinus infection (sinusitis).

Although it can be very serious, bacterial meningitis can be treated with antibiotics that can prevent severe illness and reduce the spread of infection from person to person.

Tuberculoma is a peculiar manifestation of tuberculosis which occurs in any solid organ of the body as well as in the lung. It is usually formed by conglomeration of several miliary tubercles, which form around the outer sheaths of the small cerebral blood vessels. The centre of the conglomeration becomes caseous. Caseous material gets inspissated and
sometimes liquified. A thick capsule may form around these lesions. The relative frequency of tuberculomas in the brain varies from country to country and its recent decrease in the Western countries must be correlated with the improved health standards, and striking decrease of tuberculosis in general, compared with conditions that prevailed 50 years ago.

Clinical sequelae of CNS tuberculomas are those of single or multiple intracranial mass lesions, primarily seizures and correlates of increased intracranial pressure. The features of the seizures can strongly suggest lesion location. Neuroimaging, especially MRI, is diagnostically indispensable, although biopsy remains the gold standard.

One study examining the clinical course of cerebral tuberculoma in patients with and without HIV infection found that cerebral tuberculoma in HIV-negative patients was more likely to be characterized by seizures.

Stroke remains a common and costly problem worldwide, but substantial advances have been made in recent decades in understanding stroke mechanisms, risk factors, and therapies. Because thrombosis plays an important role in the pathogenesis of ischemic stroke, drugs that interfere with hemostasis and clot formation such as anticoagulants and platelet antiaggregants commonly are used in the management of cerebrovascular disease.

Considerable evidence supports the use of certain antithrombotic drugs in stroke prevention. However, because of limited supportive data, the use of these agents in patients with acute ischemic stroke remains controversial.

Most strokes are caused by a sudden blockage of an artery in the brain (called an ischaemic stroke) that is usually due to a blood clot. Immediate treatment with antiplatelet drugs such as aspirin may prevent new clots from forming and hence improve recovery after stroke. However antiplatelet drugs may also cause bleeding in the brain which could offset any benefits. This review of 12 trials, including 43,041 participants, showed very clearly that aspirin, at a dose of 160 mg to 300 mg daily, started within 48 hours of the onset of stroke symptoms, saved lives and reduced the risk of further stroke occurring in the first two weeks.

Aspirin also increased the chances of being alive and independent and improved the chances of making a complete recovery from this stroke. The risk of serious bleeding was very low. Almost of all the evidence in this review comes from trials of aspirin. There is no reliable evidence on the effects of other antiplatelet drugs in acute stroke.

The presence of brain atrophy or loss of brain tissue due to any cause, such as old age, alcoholism, hydrocephalus, or stroke, may provide either an increased space between the dura and the brain surface where a subdural hygroma can form or traction on bridging veins that span the gap between the cortical surface and dura or venous sinuses.

Hygromas probably form after a tear in the arachnoid allows cerebrospinal fluid (CSF) to collect in the subdural space. A subdural hygroma may therefore also occur after head trauma; they are frequently asymptomatic. A minority of chronic SDH cases are derived from acute SDH cases that have matured (ie, liquified) because of lack of treatment.

Nootropics are low toxicity ‘smart drugs’ that boost brain activity and memory without affecting the nervous system

Some pharmaceuticals are called ’smart drugs’ because of their ability to enhance the brain’s function. Some smart drugs aren’t a drug at all, they’re nutrients. A more accurate description of chemicals that can boost brain performance is Nootropics (from the Greek, meaning ‘acting on the mind’).

Nootropics can enhance the brain’s natural function by helping it build additional neural connections. Neurones (brain cells) are connected to thousands of other neurones, which together form a huge neural net. The more connections you have the easier it is for one neurone to send information to another neurone, hence the better your brain works.

Citicoline in an important intermediate in the making of phospholipids in cell membranes, particularly phosphatidylcholine. When a citicoline supplement is taken by mouth, its two main components, cytidine and choline, are fully absorbed into the bloodstream. Once absorbed, citicoline is widely distributed throughout the body and is able to cross the blood-brain barrier and reaches the central nervous system (CNS), where it is incorporated into phospholipids.

Citicoline activates the biosynthesis of structural phospholipids of neuronal membranes, increases brain metabolism, and influences levels of different neurotransmitters. Citicoline has been shown to increase acetylcholine, norepinephrine and dopamine levels in the central nervous system.

Citicoline is produced from choline chloride and orotic acid by an enzymatic process. Freebase citicoline is the form marketed as a dietary supplement in the United States and as a drug in Japan. The sodium salt of citicoline, the form used in clinical trials, is sold as a drug in Europe.

Main object :
Finding the cause and treat it .
There is often no specific therapy.
Sometimes the patients were brought in irreversible condition.
Specific and supportive therapy.
Necessary treatment must be given immediately, even before all the diagnostic steps have been completed.
Diagnosis and treatment have to proceed concurrently.

Diseases that cause meningeal irritation, usually without focal or lateralizing neurologic signs. CT Scan or MRI maybe normal or abnormal.

1. Subarachnoid hemorrhage.
2. Meningitis.
3. Encephalitis

Diseases that cause focal or lateralizing neurologic signs. CT scan and MRI usually abnormal.

1. Brain hemorrhage or massive infarction.
2. Brainstem infarction.
3. Brain abscess.
4. Epidural and subdural hemorrhage, brain contusion.
5. Brain tumor.

Diseases that cause no focal or lateralizing neurologic signs, usually with normal brainstem functions.
CT scan and cellular content of the CSF are normal.
1. Intoxication.
Alcohol, barbiturates, sedative, opiates.
2. Metabolic disturbances.
Anoxia, diabetic acidosis, hypoglycemia, uremia, hepatic failure, hypo and hypernatremia, profound nutritional deficiency.
3. Severe systemic infection.
4. Shock from any cause.
5. Post seizure states and status epilepticus.
6. Hypertensive encephalopathy, eclampsia.
7. Hyperthermia, hypothermia.
8. Concussion.
9. Acute hydrocephalus.
10. Late stages of certain degenerative diseases.