Clinical features

Classically, patients with bacterial meningitis present with headache, fever, photophobia, vomiting, neck stiffness, and alteration of mental status. These are present at some stage in 85 per cent of patients. Cranial nerve palsy (particularly nerves III, IV, VI, and VII), focal neurological signs (10-20 per cent of cases), and seizures (up to 30 per cent of cases) may also occur. Papilledema is rarely seen (about 1 per cent of cases). With disease progression, signs of raised intracranial pressure (ICP), including coma, hypertension, bradycardia, and altered respiratory status, become more likely.

The presentation of meningitis may be non-specific, particularly in young children and the elderly. The elderly may be afebrile and confused or obtunded, without classical signs of meningitis. Post-neurosurgical meningitis may present with very subtle alterations in mental status, without any other signs. A high index of suspicion is necessary in all groups of patients, particularly febrile patients with altered mental status ( Segretti.and Harris 1996).

There appear to be two main patterns of clinical presentation of community-acquired meningitis. The first is a prolonged history of non-specific symptoms, including lethargy, fever, and myalgias, progressing over several days. It may be impossible to be accurate about the time of onset of meningitis. The second presentation is an acute fulminating course, with manifestations of both sepsis and meningitis. This is frequently associated with raised ICP leading to brain herniation.

Cutaneous manifestations may be seen depending on the etiology of the meningitis. Approximately 50 per cent of patients with meningococcal meningitis and most patients with meningococcal septicemia, with or without meningitis, will have a petechial or purpuric rash which may start as maculopapular.

Seizures during the early stages occur in 20 to 30 per cent of patients with bacterial meningitis. Generalized seizures are not associated with a worse outcome. Focal seizures are more likely to be associated with persistent neurological sequelae, as are focal neurological signs and cranial nerve palsies.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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