Meningitis history and symptoms


 * Associate Editor(s)-In-Chief:

History and Symptoms
In the study by Durand et.al., only 2/3 of patients had the classic triad of fever, nuchal rigidity and change in mental status.
 * All patients, however, had at least one of these findings.
 * 95% had fever >100 degrees Fahrenheit, with a mean duration of 4 days.
 * Neck stiffness was present in 88%, and contrary to other reports, was not significantly lower amongst the elderly.
 * Kernig's sign: inability to allow full extension of the knee when the hip is flexed 90 degrees.
 * Brudzinski’s sign: spontaneous flexion of the hips during attempted passive neck flexion.
 * 11% of patients had a rash, and of these cases 73% of them were due to Neisseria meningitidis (most commonly petechiae and purpura)
 * 78% of patients had an abnormal mental status, primarily lethargy and confusion.
 * 23% of the patients had focal seizures.

In general:

Headache is the most common symptom of meningitis (87%) followed by nuchal rigidity ("neck stiffness", 83%). The classic triad of diagnostic signs consists of nuchal rigidity (being unable to flex the neck forward), fever and altered mental status. All three features are present in only 44% of all cases of infectious meningitis. Other symptoms commonly associated with meningitis are photophobia (inability to tolerate bright light), phonophobia (inability to tolerate loud noises), irritability and delirium (in small children) and seizures (in 20-40% of cases). In infants (0-6 months), swelling of the fontanelle (soft spot) may be present. Vomiting may be present.