How to rule out meningitis.

Written by Zhang Hui
Neurology
Updated on September 01, 2024
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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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Written by Hu Bai Yu
Pulmonology
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Does meningitis cause fever?

Generally, patients with meningitis exhibit symptoms of fever, along with headaches, nausea, vomiting, or some cognitive impairments and confusion. It is advised that everyone should be cautious and distinguish the symptoms of meningitis from those of common colds, and perhaps visit the department of neurology at a hospital for proper diagnosis and targeted treatment. Under the circumstance of meningitis, it is crucial to follow the doctor's guidance and actively cooperate with the treatment. Typically, a regimen involving anti-infection and antiviral medications is necessary for about two to three weeks, and most patients have a favorable prognosis. Additionally, it is important to maintain a relaxed mood, avoid excessive stress, and drink adequate water to promote excretion.

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Written by Zhang Hui
Neurology
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Meningitis examination methods

The examination methods for meningitis mainly include several types. The first is the lumbar puncture examination, which is a very important diagnostic tool. Through lumbar puncture, one can observe the cerebrospinal fluid (CSF) pressure, its color, and perform laboratory tests on the CSF to examine biochemical properties and cell count changes. Additionally, it is possible to culture pathogens from the cerebrospinal fluid, which is of great auxiliary value in the diagnosis and differential diagnosis of meningitis. Secondly, patients with meningitis also need to undergo physical examinations. If signs of meningeal irritation are found during the physical examination, it also indicates meningitis. Thirdly, patients may need to undergo enhanced Magnetic Resonance Imaging (MRI) of the brain. If the meningitis lesions are severe, meningeal enhancement can be seen.

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Written by Zhang Hui
Neurology
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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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Written by Xie Wen
Neurology
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Is vomiting frequent in meningitis?

Is vomiting frequent in meningitis? There are generally two situations for frequent vomiting in meningitis. The first situation occurs when pathogens infect the meninges or brain tissue, leading to an inflammatory response in the brain tissue, which then causes brain edema and subsequently leads to increased intracranial pressure. When intracranial pressure increases, it can cause vomiting, and this type of vomiting becomes projectile. Therefore, when vomiting is frequent and projectile, accompanied by severe headaches, fever, or even changes in condition, it is necessary to be vigilant about the increase in intracranial pressure leading to the formation of brain herniation, a situation that must be urgently addressed. The second reason is that after the pathogen enters the blood, it invades the gastrointestinal tract. An infection of the gastrointestinal tract itself can also cause frequent vomiting, accompanied by diarrhea, or even gastrointestinal bleeding, etc.

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Written by Zhang Hui
Neurology
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sequelae of meningitis

Firstly, it may cause meningitis adhesions leading to hydrocephalus. Once hydrocephalus occurs, it may leave cognitive impairments as sequela, such as slow response, memory decline, and reduced executive functions. Secondly, tuberculous meningitis might also damage cranial nerves, resulting in symptoms such as diplopia, difficulty swallowing with choking on water, and dysarthria. If it affects the facial nerve, peripheral facial paralysis and other sequelae might occur. Thirdly, it could also lead to arteritis. The occurrence of arteritis can cause arterial occlusion, leading to the formation of cerebral infarction.