Bacterial meningitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Physical examination

Adults

The physical examination findings in adults may include the following:

General appearance

• Patient may look distressed
• Altered mental status-not oriented in time, place and person

Vital signs

• Bradycardia may indicate increased intracranial pressure
• Increased or decreased temperature

HEENT

• Signs of infection indicating sinusitis, mastoiditis, and otitis media may help identify the source of infection and give a clue about diagnosis.
• Papilledema may indicate increased intracranial pressure.
• Neck stiffness is strongly suggestive of meningitis.

CVS

• Decreased heart rate indicates increased intracranial pressure

CNS

• Signs of neurological deficit may not be present.

Skin

• Presence of skin rash may indicate Neisseria meningitidis infection

Special tests

There are two special tests for meningitis:

• Kernig's sign

• Postive kernig's sign indicate meningitis.

• Brudzinski's sign

• Positive brudzinski's sign may suggest meningitis with a sensitivity of and specificity of

Infants

• Neck stiffenss
• Altered mental status
• Bulging fontanelle
• Convulsions

References

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