Nausea and vomiting are common in meningitis as the rising intracranial pressure exerts pressure on the control centers of the brain that stimulate vomiting. In situations when intracranial pressure is extremely high (hemorrhage, for example), we often see classic projectile vomiting.
A sudden high fever is one of the key signs of meningitis and may be accompanied by chills. A high fever increases the metabolic rate and can lead to insensible fluid loss, so be sure to assess for dehydration and encourage adequate fluid intake.
Nuchal rigidity, also known as a stiff neck, is another key sign of meningitis. In conjunction with this, a positive Kernig’s sign or Brudzinski’s sign may be present. A positive Kernig’s sign is assessed when pain limits passive extension of the knee when lying supine with the hip and knee flexed at 90 degrees. A positive Brudzinski’s sign is when flexion of the neck causes involuntary flexion of the knee and hip.
A severe headache that isn’t like any other type of headache is often present. Headaches may continue for several months until inflammation and irritation are resolved. It is important to implement pain management.
Purpura is a dark purple rash that occurs on the skin. This symptom is characteristic of meningococcemia, or meningococcal infection in the bloodstream. This condition is associated with septic shock-like symptoms and will have a rapid onset. Treat immediately, as death can occur as quickly as in a few hours.
Seizures often occur due to irritation of the cerebral cortex and a high fever unresponsive to antipyretics or cooling blankets. Bacterial infections have a higher incidence of seizure activity.
Photophobia, known as increased sensitivity to light, is another possible symptom of meningitis.
Opisthotonus is a position of severe hyperextension of the head, neck, and spinal column resembling a bridging or arching position. It is often pronounced in infants with meningitis.
A high-pitched cry or constant crying may be a sign of meningitis.
Infants with meningitis may have a bulging fontanel (soft spot on the head).
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