The AAO Journal, 2024/06, 34(2):8. doi: 10.53702/i2375-5717-34.2.7, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/7/500955/LBORC-NUFA-Poster-Abstracts-2024-Clinician-amp)

Keywords:

case report [736]
male [860]
meningitis [1]
OMT [3924]
osteopathic manipulative treatment [3945]

Abstract:

Introduction/Background: The inflammation of the meninges in meningitis disrupts the blood-brain barrier, causing significant cerebral edema. Currently, no literature supports the association between tentorium cerebelli (tent) dysfunction and acute meningitis. Identifying this crucial somatic dysfunction could expedite early diagnosis and streamline the work-up process. Moreover, Osteopathic Manipulative Treatment (OMT) directed at the tent could directly influence cranial lymphatic and glymphatic drainage. The tent’s close connection to brain glymphatics may improve infection visibility for the immune system, decrease intracranial pressure, and symptomatically alleviate associated neck pain in patients. Case: 57-year-old male presented with 2 week history of right-sided throbbing headaches, weakness, weight loss, diarrhea, cough, and fatigue. A delayed spinal tap confirmed a diagnosis of Cryptococcus Meningitis. This patient decompensated despite having received standard of care and daily OMT, including osteopathy in the cranial field and balanced ligamentous tension, until the patient was transitioned to comfort measures. Results: Daily OMT was provided as a part of the patient’s hospitalization with reduction in the patient’s somatic dysfunctions and neck pain. There was delay in obtaining the spinal tap due to the pursuit of other workup, but the clinical finding of tent tension was present and could have served as an early diagnostic clue. Discussion: This clinical finding seems to be significant in the setting of meningitis. The quality of the tent dysfunction is unique enough due to the acute infectious changes and local congestion of the glymphatics from that of regular membranous strain that a trained osteopath would be able to discern the difference and warrant further work-up. Having had the ability to evaluate the patient prior to the onset of meningitis would have served a useful contrast.