From the Guidelines
The signs of meningitis include fever, headache, neck stiffness, and altered mental status, although these symptoms may not always be present together 1.
Common Signs and Symptoms
- Fever: present in 77-97% of cases 1
- Headache: present in 58-87% of cases 1
- Neck stiffness: present in 65-83% of cases 1
- Altered mental status: present in 54-69% of cases 1
- Rash: present in 20-52% of cases, often indicative of meningococcal infection 1
Less Reliable Signs
- Kernig's sign and Brudzinski's sign have low sensitivity and are not helpful in diagnosing meningitis 1
Important Considerations
- The "classic triad" of fever, neck stiffness, and altered mental status is only present in 41-51% of cases 1
- The absence of these signs and symptoms does not rule out meningitis, and cerebrospinal fluid examination is still recommended in suspected cases 1
From the Research
Signs of Meningitis
The signs of meningitis can be identified through various clinical examinations and tests. Some of the common signs include:
- Headache
- Vomiting
- Fever
- Neck stiffness
- Altered mental status
- Nuchal rigidity
- Kernig's sign
- Brudzinski's sign
Clinical Examination
Clinical examination for meningitis can be challenging due to the lack of sensitivity of clinical signs. However, the absence of two signs among fever, headache, neck stiffness, and altered mental status can eliminate meningitis with a negative predictive value of 95% 2. The classical signs of meningitis, such as nuchal rigidity, Kernig's sign, and Brudzinski's sign, rely on the principle that stretching the inflamed meningeal membranes causes clinically detectable irritation 3, 4.
Diagnostic Performance
The diagnostic performance of clinical examination in detecting meningitis can vary significantly due to methodological differences, clinical heterogeneity, and interobserver variability 3. However, positive meningitic signs can increase the likelihood of a diagnosis of meningitis, and the absence of meningitic signs can reduce this probability 3. Familiarity with all the meningeal signs is desirable, as some may be present while others are absent 4, 5.
Chronic Meningitis
Chronic meningitis is defined as an inflammatory cerebrospinal fluid (CSF) profile that persists for at least 1 month, and its presentation often includes headache, nausea, vomiting, cranial neuropathies, symptoms of elevated intracranial pressure, or focal neurologic deficits 6. Evaluation of the patient with suspected chronic meningitis should include a detailed history and physical examination, as well as repeated CSF diagnostics, serologic studies, and biopsy of the brain or other abnormal tissue, when indicated 6.