WEEKLY TOP 7 – Top 7 clinical signs of meningitis

These days medical students are just flooded with a huge amount of information –different description of diseases, fresher and fresher publications – available online. It is really difficult to pick the clinically relevant data, especially when you do not have those years of practice behind your back. In our blog series You will find short and straightforward lists of clinical signs, symptoms which are the most typical and pathognomonic in certain diseases.

During the 2018 World Meningitis Awareness Week, let’s focus on this insidious, deadly disease. Indeed, it deserves the attention - meningitis can be hard to recognize in the early stages, can affect anyone of any age at any time and most importantly: 10 - 20% of patients will die within the first 24 to 48 hours! If you recognize some of the symptoms listed below in your patient, do not hesitate to check whether they are in serious danger!

1. Meningism

Why? Meningitis is the inflammation of the membranes surrounding your brain and spinal cord. The swelling of meninges triggers a set of symptoms called “meningism”. These symptoms are:

High fever

Severe or unusual headache - manifests as constant, shrill cry in newborns and toddlers

Neck stiffness

Take-home message: the meningeal signs have low sensitivity. The absence of the Kernig’s sign and Brudzinski’s sign does not mean that the patient  is not suffering from meningismus!

2. Nausea, vomiting

Why? The chemoreceptor trigger zone of the brain is irritated by the ongoing inflammation and this leads to nausea and vomiting.

3. Altered mental state

Why? If something is wrong with the brain (or at least with its environment), it will have effects on the mental state for sure. AMS can manifest as irritability, confusion, drowsiness, delirium or even coma. Paradoxical irritability can be a nonspecific sign of meningitis in children younger than 3 months (quiet at rest but crying when moved)!

4. Convulsions

Why? Neural activity and neural function are affected by the inflammation. The pathophysiologic firing of neurons might cause convulsions.

5. Bulging fontanelle

Why? Symptoms of meningitis in infants and newborns can differ from the typical signs you can see in adults. Increased intracranial pressure (ICP) due to inflammation causes tense, bulging fontanelles.

6. Tachypnoe or apnoe

Why? Again, another common non-specific sign of meningitis in children. Irritation of the respiratory centers due to meningitis leads to altered breathing patterns, especially in infants.

7. Macules and petechiae (rapidly evolving into purpura)

Why? A rash that does not fade under pressure is a sign of meningococcal septicaemia caused by Neisseria meningitidis; a bacterium that can cause meningitis and septicaemia at the same time. The endotoxins of the germ lead to endotoxic shock, causing vascular collapse manifesting in rash.

After learning the basics, test your knowledge in practice by solving cases in InSimu Patient app! You can download it for iOS or Android.

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