What are the symptoms of meningitis?

Written by Liu Shi Xiang
Neurology
Updated on September 26, 2024
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The symptoms of meningitis mainly include headache, nausea, vomiting, fever, epileptic seizures, and mental abnormalities. Severe cases may also present with disturbances in consciousness and signs of meningeal irritation, among others. Therefore, when a patient exhibits the above symptoms, the possibility of meningitis should be considered. The patient needs to promptly visit the neurology department to undergo a cranial CT scan, cranial MRI, electroencephalogram, and lumbar puncture for cerebrospinal fluid analysis to confirm the diagnosis. Treatment should be based on the test results, selecting appropriate anti-infective medications. For example, patients with viral meningitis should be treated with antiviral medications such as acyclovir and ganciclovir; patients with bacterial meningitis should be treated with potent antibacterial drugs, including carbapenems and quinolones; patients with tuberculous meningitis should receive antitubercular drugs, such as isoniazid, rifampin, and ethambutol. In addition, patients may also need symptomatic treatments such as dehydration to reduce intracranial pressure, fever reduction, and control of psychiatric symptoms. (Medication should be used under the guidance of a doctor.)

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Differentiation between purulent meningitis and viral meningitis

Purulent meningitis and viral meningitis are different diseases. Purulent meningitis is caused by bacterial infection of the meninges. Viral meningitis is caused by viral invasion of the meninges. Generally, purulent meningitis is more severe, and patients may exhibit symptoms of systemic toxin poisoning, such as high fever, nausea, vomiting, sickly appearance, and general weakness. The symptoms of viral meningitis are relatively mild, and the fever is not particularly severe. Another important differentiation is based on the analysis of cerebrospinal fluid. In viral meningitis, the lumbar puncture shows that the white blood cell count is below 1000*10^6/L, and the levels of sugar and chloride are generally normal or slightly low, with protein usually mildly elevated. In purulent meningitis, the cerebrospinal fluid shows a significant increase in white blood cell count, even reaching from 1000*10^6/L to 10000*10^6/L; the protein content is significantly increased, the sugar content is markedly decreased, and chloride levels are reduced. Additionally, bacteria can be found in the cerebrospinal fluid and blood cultures in purulent meningitis, whereas viral meningitis cerebrospinal fluid cultures do not show bacteria.

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Written by Han Shun Li
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Is meningitis scary?

Is meningitis a frightening disease? Meningitis can be very frightening if the condition progresses quickly, or if it is not diagnosed and treated in a timely manner. In severe cases, it can be life-threatening. Many patients often suffer from after-effects following recovery, such as decreased intelligence, dementia, aphasia, paralysis, etc., significantly impacting the quality of life. Therefore, meningitis is a quite frightening disease, and patients should actively cooperate with doctors for treatment to save lives and minimize or reduce the occurrence of after-effects.

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How to rule out meningitis.

Patients with meningitis usually show clinical symptoms such as fever, headache, nausea, and vomiting. To rule out meningitis, the following points should be considered. The first point is to check if the patient has a relevant medical history. If the patient's symptoms are very normal, without fever or headache, the possibility of meningitis is generally not very high. The second point is to pay attention to the physical examination, to see if there is any sign of meningeal irritation. If there is no meningeal irritation, it also does not support the presence of meningitis. The third point involves performing a lumbar puncture to examine the cerebrospinal fluid, checking if the pressure of the cerebrospinal fluid is high, and whether the cellular and biochemical properties within the fluid are normal. If completely normal, the likelihood of meningitis is also very small. Additionally, if necessary, an enhanced MRI scan of the brain should be performed, as meningitis usually shows enhancement.

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Differences between Viral Meningitis and Tuberculous Meningitis

Virial meningitis and tuberculous meningitis sometimes require additional differentiation in clinical practice because their treatment plans are significantly different. Virial meningitis has a relatively abrupt onset and is caused by a viral infection, generally having a good prognosis. Patients with tuberculous meningitis usually exhibit symptoms of tuberculosis toxicity such as low fever, night sweats, and fatigue before the onset of the disease. Commonly, other forms of tuberculosis can be identified, such as pulmonary tuberculosis or intestinal tuberculosis. An important diagnostic tool for differentiation is the lumbar puncture. In viral meningitis, the lumbar puncture pressure is generally not particularly high, whereas in tuberculous meningitis, the lumbar puncture pressure is very high, reaching over 400 mm of water column. Additionally, the cerebrospinal fluid (CSF) in tuberculous meningitis is yellowish, and its protein levels are significantly elevated, as are its white blood cell counts, typically ranging from 50 to 500 × 10^6/L. In tuberculous meningitis, the levels of glucose and chloride in the cerebrospinal fluid are significantly decreased, especially chloride, which is a prominent indicator for diagnosing tuberculous meningitis. In contrast, such clear changes are not observed in the lumbar puncture for viral meningitis. Another aspect to consider is the treatment response; if antiviral treatment is ineffective, the possibility of tuberculous meningitis should be considered.

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How to test for meningitis?

Meningitis is a very common disease in neurology, and the most common causes are infections, including viral infections, common bacterial infections, tuberculosis infections, and fungal infections. The main methods of examination for meningitis are as follows: First, physical examination. A physical examination can reveal neck stiffness in the patient, and positive meningeal irritation signs. These examinations are non-invasive and very safe. Second, a lumbar puncture can also be performed. A lumbar puncture can be used to observe whether the fluid pressure is high, and also to collect cerebrospinal fluid to examine its color, perform cytological and biochemical analyses, and culture the cerebrospinal fluid. This is very important to definitively determine the presence of meningitis and to identify the type of infectious agent involved. Additionally, enhanced magnetic resonance imaging can also be performed to see if there is significant enhancement of the meninges.