PROBLEM 3.

01 NERVOUS SYSTEM STUDY GUIDE 5 In general, people older than 2 years of age with acute
bacterial infection develop high fever, severe headache, stiff
1. CLINICAL FEATURES OF MENINGITIS. neck, nausea, vomiting, discomfort when looking into a
IN NEONATES bright light, sleepiness, and confusion.
Newborns and infants can be unusually fussy, irritable, and
 Poor feeding sleepy. They may feed poorly and not be comforted by
 Lethargy holding. Seizures can be a late development of the disease.
 Irritability
Severe forms of bacterial meningitis, particularly
 Apnea meningococcal, can cause shock with complete loss of
 Listlessness consciousness and coma and bring about a spreading
 Apathy purplish rash. An infant can have bulging fontanelles (soft
 Fever spots) on the head and have a decreased muscle tone in
arms and legs.
 Hypothermia
 Seizures
 Jaundice
 Bulging fontanelle
 Pallor
 Shock
 Hypotonia
 Shrill cry
 Hypoglycemia
 Intractable metabolic acidosis
IN INFANTS AND CHILDREN
 Nuchal rigidity
 Opisthotonos
 Bulging fontanell Someone with viral brain infections tends to appear
 Convulsions
 Photophobia
 Headache
 Alterations of the sensorium
 Irritability somewhat less ill. Flu-like symptoms in addition to mild signs
 Lethargy and symptoms outlined for each condition may be seen.
 Anorexia
 Nausea
 Vomiting FOR MENINGEAL IRRITATION
 Coma
 Fever (generally present, although some severely ill
children present with hypothermia)
IN ADULTS
Fever, headache, stiff neck, and altered mental status.
Other symptoms can include the following:
 Nausea
 Vomiting
 Photalgia (photophobia) - Discomfort when the patient
looks into bright lights
 Sleepiness
 Confusion
 Irritability
 Delirium
 Coma
2. NONSPECIFIC MENIFESTATIONS OF MENINGITIS:
 Fever
 Irritability
 Lethargy
 Poor feeding high pitched cry and bulging ant.
Fontanelle
 Convulsions
 Headache
 Hypotension
 Tachycardia
FOR INTRACRANIAL INFECTION
Various types of brain infections lead to many different
symptoms, which can depend on the age of the person, the
type of bacteria, the type of infection, and the acuteness of
the disease.
3. LUMBAR PUNCTURE. 4.

APPROACH CONSIDERATIONS
After the age of 3 months, the child may display
symptoms more often associated with bacterial
meningitis, with fever, vomiting, irritability,
lethargy, or any change in behavior. After the
age of 2-3 years, children may complain of
headache, stiff neck, and photophobia.
Bacterial meningitis is a medical emergency. A
firm diagnosis is usually made when bacteria are
isolated from the cerebrospinal fluid (CSF) and
evidence of meningeal inflammation is
demonstrated by increased pleocytosis, elevated
protein level, and low glucose level in the CSF.
Specific hematologic, radiographic (eg,
computed tomography [CT] and magnetic
resonance imaging [MRI]), and other studies
assist in diagnosis.
Blood studies that may be indicated include the
following:
 Complete blood count (CBC) with
differential
 Blood cultures
 Coagulation studies
 Serum glucose
 Electrolytes
Measurement of the serum glucose level close to
the time of CSF collection is helpful for interpreting
CSF glucose levels and assessing the likelihood of
meningitis.
Bacterial antigen studies can be performed on urine
and serum and can be useful in cases of pretreated
meningitis; however, a negative bacterial antigen
study result does not rule out meningitis. The group B
streptococcal (GBS) antigen test in urine is unreliable
and should not be used to make a diagnosis of sepsis
or meningitis.
Definitive diagnosis is based on examination of CSF
obtained via lumbar puncture.
CT and MRI may reveal ventriculomegaly and sulcal
effacement.