Meningism

Evidence of meningeal irritation caused by infection or subarachnoid haemorrhage results in characteristic clinical features:

SYMPTOMS

1. Headache

2. Vomiting

3. Photophobia

SIGNS

Neck stiffness

SIGNS

Neck stiffness

Kernig's sign: stretching nerve roots by extending the knee causes pain.

INVESTIGATION

Clinical features of meningism

No clinical evidence of a mass lesion (alert, no focal signs, no papilledema)

Lumbar puncture

|WBC count >5 cells/mm3 or if traumatic tap |WBC:RBC ratio (normal <1:500)

No mass lesion or evidence of haemorrhage

Clinical evidence of a mass lesion (papilloedema, focal neurological signs, impaired conscious level)

CT scan

Xanthochromia or uniformly bloodstained CSF

MASS LESION

INFECTION

SUBARACHNOID HAEMORRHAGE

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