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Clinical Features of Meningitis
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Clinical Features of Meningitis

Topics / Medical / Meningitis

Clinical Features of Meningitis

Think of it this way, bacterial meningitis is really bad. Keep this in mind when differentiating the different types of meningitis. You need to realize that a bacteria is a glucose-consuming, brain-destroying bug.  For this reason, although viral and bacterial present in a similar maner. Viral meningitis is usually a bit less acute. Both viral and bacterial meningitis usually present in a more acute time frame, while other forms of meningitis such as the ones caused by Cryptococcus and Tuberculosis have a more, slower, chronic time frame.

Symptoms

In neonates, meningitis often presents with very non-specific symptoms and without the usual classic triad of meningitis. Some of the symptoms include:

  1. Hypotonia
  2. Lethargy
  3. Irritability
  4. Vomiting, Not Tolerating Feeds
  5. Dysregulation of temperatures: Hyperthermia or hypothermia
  6. Seizures

 

While in children and adults, we may see the more typical presentation of meningitis, some of the symptoms include:

  1. The Classic triad: Fever, headache and neck stiffness
  2. Altered mental status
  3. Photophobia
  4. Nausea, Vomiting
  5. Seizures
  6. If the patient has N. meningitidis, then the patient may present with symptoms such as myalgia, a purpuric rash. This rash is usually a non-blanchable cutaneous or mucosal lesion which results from blood “leaking” (extravasation) into the skin or mucosa.

Signs

The physical findings may range from very subtle sings to signs suggestive a complicated meningitis. 

  1. Meningism
    1. Neck Stiffness
    2. Kerning Sign – Knee Extension is painful.
    3. Brudzinski Sign – Neck flexion leads to hip and knee flexion.
  2. Others
    1. Fever
    2. Altered level of consciousness
    3. Signs of increased intracranial pressure: papilloedema
    4. Signs suggestive of meningococcal meningitis: Non-blanching rash
    5. Children: Papillodema, “Setting sun” sign, dilated scalp veins, tense bulging anterior fontanelle, increased head circumference, positive transillumination

Complications

Meningitis may also present with signs suggestive of a complication.

  1. Neurological
    • Acute Onset
      • altered mental status
      • coma
      • cerebral edema
      • raised intracranial pressure
      • acute onset seizures
      • subdural empyema
      • hydrocephalus
      • hearing loss
      • hemiparesis, quadriparesis
      • blindness
    • Late Onset
      • late onset seizures (epilepsy)
      • cerebrovascular complications
      • neuropsychiatric complications
      • developmental complications, cerebral palsy
      • intellectual deficit 
  2. Non-Neurological
    • septic shock
    • DIC
    • hypothalamic and endocrine dysfunction
    • electrolyte imbalance, SIADH
    • adrenal hemorrhage
Published on October 16, 2022
Dr RW Becerra Estevez
Dr RW Becerra EstevezMBChB (WSU)

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