From the Guidelines
The most common presenting complaint for meningitis is headache, often accompanied by fever and neck stiffness (nuchal rigidity). This classic triad of symptoms occurs as inflammation of the meninges irritates pain-sensitive structures and triggers systemic inflammatory responses. According to the study by Van de Beek and colleagues 1, the clinical features of meningitis can vary, but headache, fever, and neck stiffness are common symptoms. The study also notes that the "classic triad" of neck stiffness, fever, and altered consciousness was present in less than 50% of cases. Another study published in the Clinical Microbiology and Infection journal 1 also found that headache, fever, neck stiffness, and altered mental status are common signs and symptoms at admission, with the classic triad reported in only 41-51% of patients.
Clinical Presentation
The clinical presentation of meningitis can vary depending on the age and immune status of the patient. In adults, the symptoms can develop rapidly over hours to days, while in infants and young children, the symptoms may be non-specific, such as irritability, poor feeding, lethargy, or a bulging fontanelle. Elderly patients may present with confusion rather than the typical symptoms. The headache of meningitis is typically severe, diffuse, and unrelenting, worsening with movement or maneuvers that increase intracranial pressure.
Importance of Prompt Evaluation
Anyone presenting with sudden severe headache, especially when accompanied by fever and neck stiffness, should be evaluated promptly for meningitis as delayed treatment, particularly in bacterial cases, can lead to serious complications or death. The absence of neck stiffness, Kernig sign, and Brudzinski sign cannot be used to exclude the possibility of bacterial meningitis, as these clinical findings have low diagnostic accuracy for prediction of cerebrospinal fluid (CSF) pleocytosis 1.
Key Points
- The most common presenting complaint for meningitis is headache, often accompanied by fever and neck stiffness (nuchal rigidity)
- The classic triad of symptoms occurs in less than 50% of cases
- Clinical presentation can vary depending on age and immune status
- Prompt evaluation is crucial to prevent serious complications or death
- Absence of neck stiffness, Kernig sign, and Brudzinski sign cannot be used to exclude bacterial meningitis 1
From the Research
Presenting Complaints of Meningitis
The most common presenting complaints for meningitis include:
- Altered mental status, neck stiffness, headache, and fever 2
- Severe headache, fever, and diarrhea 3
- Fever, otalgia, neck stiffness, headache, and confusion 4
- Headache, neck stiffness, and photophobia, possibly with additional non-specific symptoms such as diarrhoea or sore throat 5
Common Symptoms
Common symptoms of meningitis include:
- Headache 2, 3, 4
- Fever 2, 3, 5, 4
- Neck stiffness 2, 3, 5, 4
- Altered mental status 2
- Diarrhea 3, 5
- Otalgia 4
- Confusion 4
- Photophobia 5
Classic Triad
The classic triad of neck stiffness, fever, and altered consciousness is present in less than 50% of cases of bacterial meningitis 5 and less than 21.4% of all patients with meningitis 6