Which physical findings suggest 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

Some general physical findings in viral meningitis are common to all causative agents.

The classically taught triad of meningitis consists of fever, nuchal rigidity, and altered mental status, but not all patients have all 3 symptoms.

Fever is common (80-100% of cases) and usually ranges from 38°-40°C.

Nuchal rigidity or other signs of meningeal irritation (Brudzinski or Kernig sign) may be seen in more than half of patients, but these symptoms are generally less severe than they are in bacterial meningitis. Pediatric patients, especially neonates, tend not to exhibit nuchal rigidity on examination.

Irritability, disorientation, and altered mentation may be seen.

Severe lethargy or bulging fontanelle in neonates is a sign of increased intracranial pressure but may be absent in more than half of all cases. The neonate may exhibit hypotonia, irritability, and poor feeding. The clinical picture can mimic neonatal bacterial septicemia accompanied by multiple organ system involvement.

Headache is common and is characteristically severe.

Photophobia is relatively common but may be mild. Phonophobia may also be present.

Seizures occur occasionally and are usually a result of the fever, although the involvement of brain parenchyma (encephalitis) should be considered.

Global encephalopathy and focal neurologic deficits are rare but can be present. Deep tendon reflexes are usually normal but may be brisk.


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