Question

A 25-year-old lady is admitted in the ward with recent onset high grade fever. She is being evaluated for suspected meningitis.
What are the clinical features in a patient with meningitis?

Hint:

In meningitis, the combination of fever, headache, and nuchal rigidity strongly suggests the diagnosis. Always check for signs of raised intracranial pressure.

Answer 1

Step 1: Fever.
Fever is a hallmark symptom of meningitis, and it is usually high grade, accompanied by chills.

Step 2: Headache.
A severe headache is common and is often described as different from a typical headache, more intense and unrelieved by usual analgesics.

Step 3: Neck Stiffness (Nuchal Rigidity).
Nuchal rigidity is a classic sign of meningitis. The patient often experiences difficulty flexing the neck forward due to inflammation of the meninges.

Step 4: Photophobia.
Sensitivity to light is a common feature, as the inflammation affects the meninges that cover the eyes.

Step 5: Nausea and Vomiting.
Nausea and vomiting often accompany the headache and can worsen with changes in position.

Step 6: Altered Mental Status.
Confusion, lethargy, or irritability are common symptoms in patients, especially as the infection progresses.

Step 7: Seizures.
In severe cases, meningitis can lead to seizures, which may indicate increased intracranial pressure or cerebral involvement.

Step 8: Conclusion.
The clinical presentation of meningitis involves systemic signs like fever and headache, as well as neurological features such as neck stiffness, photophobia, and altered mental status. Early recognition is essential for timely intervention.