Meningitis
Description
- Inflammation of the leptomeninges - pia and arachnoid - and the CSF within the subarachnoid space
- Classic triad: fever + neck stiffness + altered mental state
- *All three present in fewer than half. But ~95% have at least two of fever, headache, neck stiffness or altered mental state*
- Meningism = headache, photophobia, neck stiffness (Kernig and Brudzinski signs are specific but insensitive)
- Meningitis vs encephalitis vs meningoencephalitis
- Meningitis - meningeal irritation, normal cerebral function
- Encephalitis - altered conscious state, personality change, seizures, focal deficit = brain parenchymal involvement
- The distinction drives empirical therapy: encephalitis mandates aciclovir
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