What are the signs and symptoms of viral meningitis?

Updated: Jul 17, 2018
  • Author: Cordia Wan, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Upon presentation, most patients report fever, headache, irritability, nausea, vomiting, stiff neck, rash, or fatigue within the previous 18-36 hours. Constitutional symptoms of vomiting, diarrhea, cough, and myalgias appear in more than 50% of patients.

For several weeks or longer, children may experience irritability, incoordination, and an inability to concentrate.

Headache is almost always present in patients with viral meningitis and is often reported as severe. However, the classic description of abrupt onset of the "worst headache of my life," attributable to aneurysmal subarachnoid hemorrhage, is uncommon.

History of temperature elevation occurs in 76-100% of patients who come to medical attention. A common pattern is low-grade fever in the prodromal stage and higher temperature elevations at the onset of neurological signs.

Younger children may not report headache and may simply be irritable.

Newborns may present with poor feeding and lethargy.

Some viruses cause rapid onset of the above symptoms, while others manifest as nonspecific viral prodromes, such as malaise, myalgia, and upper respiratory symptoms. In many cases, symptoms have a biphasic pattern; the nonspecific flu-like symptoms and low-grade fever precede neurologic symptoms by approximately 48 hours. With the onset of neck stiffness and headache, the fever usually returns.


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