NEURAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 188

vidual must not be left alone for at least twelve hours, the time in which recurrences are
most likely.
Individuals should consult a physician for a first seizure. If they are in a wilderness
situation, they should be evacuated. Following a seizure that continues for more than five
minutes, when breathing difficulty is present and confusion or unconsciousness persists,
emergency care should be sought. Occasionally, injuries sustained during a seizure require
emergency treatment.
Meningitis and Encephalitis
Meningitis is an infection of the membranes surrounding the brain and spinal cord, usu-
ally caused by bacteria. Encephalitis is an infection of the brain itself, most commonly
caused by a virus. These diseases produce similar signs and symptoms, in the wilderness
would be treated the same, and are discussed as a single category. (Rabies, a form of en-
cephalitis, is discussed in Chapter 32: Rabies . )
Bothmeningitisandencephalitis arespreadbyhumancontactorbyinsects,particularly
mosquitoes. Meningitis can result from the direct spread by bacteria from a chronic infec-
tion of areas such as the sinuses, ears, or mastoids or from an open fracture of the skull. A
number of organisms can cause meningitis or encephalitis, and each organism varies in the
effects it produces. The signs, symptoms, and severity of this group of infections cover a
wide spectrum.
Individuals with meningitis or encephalitis often have had a recent upper respiratory in-
fection, such as a cold or sore throat. Headache, usually severe, is the most common initial
symptom. Fever is usually present and may be high. Nausea and vomiting sometimes oc-
cur. An abnormal sensitivity to or intolerance for light (photophobia) is a common symp-
tom. Paralysis is rare and usually affects only one or two nerves: those originating in the
brain more commonly than those fromthe spinal cord.Seizures occur inabout one-third of
individuals with meningitis. Confusion, delirium, or coma may ensue and are fairly com-
mon with encephalitis.
The most specific diagnostic signs of central nervous system infections result from in-
volvementofthefibrousmembranesthatcoverthebrain,whichareinflamedseverelywith
meningitis and to some extent with encephalitis. Movement of these membranes by bend-
ing the neck or back causes pain. To prevent such movement, the muscles surrounding the
vertebralcolumngointospasm.Individualswithoneofthesedisordersareunabletotouch
their chins to their chest, although that maneuver is normally very easy. If placed on the
back and the leg is lifted with the knees bent, straightening the leg causes pain in the back.
Thismaneuver pullsonnervesintheleg,whichproducesmovement ofthespinalcordand
its coverings, resulting in pain.
The treatment for meningitis and encephalitis consists primarily of control of the infec-
tion.Largeamountsofantibioticsareneededandshouldbegivenintravenouslyifpossible,