Meningitis

Question 1

What is means by “meningism”

Answer 1

A symptom complex consisting of:

• headache
• photophobia
• vomiting
• neck stiffness (due to muscle spasm)

Question 2

What conditions can cause meningism as part of their clinical presentation?

Answer 2

Meningitis
Sub-arachnoid haemorrhage
Migraine
Infection with bacteraemia
Viral infections e.g. influenza

Question 3

What type of cells are predominantly found in CSF in bacterial vs viral meningitis?

Answer 3

Baccterial: neutrophils
Viral: lymphocytes
(TB: lymphocytes or mixed)

Question 4

What level of glucose would be found in the CSF of a patient with bacterial vs viral meningitis?

Answer 4

Bacterial: low glucose
Viral: normal glucose
(TB: low glucose)

Question 5

What level of protein would be found in the CSF of a patient with bacterial vs viral meningitis?

Answer 5

Bacterial: greatly increased
Viral: moderately increased

Question 6

Describe the pathogenesis of meningitis

Answer 6

1. Attachment to mucosal epithelial cells (eg, bacteria and mumps virus to nasopharyngeal and oropharyngeal mucosa, enteroviruses to intestinal mucosa).
2. Transgression of the mucosal barrier.
3. Survival in the blood stream.
4. Entry into CSF.
5. Production of overt infection in the meninges with or without brain infection (encephalitis).

Question 7

Which three bacteria are most commonly implicated in bacterial meningitis?

Answer 7

• Neisseria meningitidis
• Streptococcus pneumoniae
• Haemophilus influenzae

Question 8

What is Kernig’s sign?

Answer 8

with the hip flexed, the patient’s leg cannot be straightened due to hamstring spasm in meningism