Neurology · MU Sofia

41. Meningitis: classification, meningeal syndrome, CSF syndrome, examination, differential diagnosis

Covers meningitis as inflammation of the meninges, classified by cause (bacterial, viral, tuberculous, fungal) and by course. It then sets out the meningeal syndrome, the CSF findings for each type, the bedside examination, and a differential diagnosis against subarachnoid haemorrhage, encephalitis, raised intracranial pressure, migraine and cervical spine disease.

Inside: 1 section · 16 flashcards · 2 min

Topic 41 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 238 words (2 min of reading), with 16 flashcards.

In this note

  1. Meningitis - classificaiton, meningeal syndromes, CSF syndrome, examination, differential diagnosis

Meningitis - classificaiton, meningeal syndromes, CSF syndrome, examination, differential diagnosis

Definition: Meningitis is inflammation of the meninges (pia, arachnoid, subarachnoid space), usually due to infection.

Classification

A. By Etiology

1. Bacterial (acute purulent): Most severe, emergency condition

2. Viral (aseptic meningitis): Usually milder course

3. Tuberculous meningitis: Subacute/chronic, severe complications

4. Fungal meningitis: Immunocompromised patients

B. By Course: Acute (bacterial). Subacute (TB). Chronic (fungal, TB)

Meningeal Syndrome (Clinical Features)

  • General Symptoms: Severe diffuse headache. Fever (usually). Nausea, vomiting (often projectile). Photophobia. Malaise
  • Meningeal Signs: Neck stiffness (nuchal rigidity). Kernig sign positive. Brudzinski sign positive
  • Severe Cases: Altered consciousness. Seizures. Focal neurological deficits (complications)

CSF Syndrome in Meningitis

A. Bacterial Meningitis: ↑ Opening pressure. Turbid CSF. ↑ Neutrophils (pleocytosis). ↑ Protein. ↓ Glucose

B. Viral Meningitis: Clear CSF. ↑ Lymphocytes. Mild ↑ protein. Normal glucose

C. Tuberculous Meningitis: Clear/slightly cloudy. ↑ Lymphocytes. ↑↑ Protein. ↓ Glucose

D. Fungal Meningitis: Lymphocytic pleocytosis. ↑ Protein. ↓ Glucose

Examination

  • General Examination: Fever. Toxic appearance. Rash (meningococcal infection)
  • Neurological Examination
  • Meningeal irritation signs: Neck rigidity. Kernig sign. Brudzinski sign
  • Cranial nerves: May show palsies (especially VI nerve → diplopia)
  • Consciousness: Confusion → coma in severe cases

Differential Diagnosis

A. Subarachnoid Hemorrhage: Sudden “thunderclap” headache. Blood in CSF. No infection signs

B. Encephalitis: Prominent altered mental status. Focal neurological signs. Seizures early

C. Brain Tumor / Increased ICP: Gradual headache progression. Papilledema. No fever (usually)

D. Migraine: Recurrent headaches. No fever or meningeal signs

E. Cervical spine disease: Neck pain but no systemic infection

Read the full note free

The whole note is free with an AceMed account, with its 16 flashcards. Premium adds flashcard recall, highlights and Ask AI.

Start freeAlready a member? Open the note