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Meningitis

The first signs of meningitis may be quite general and may simply consist of:

• headache
• high temperature
• tiredness
• irritability

There may also be gastrointestinal symptoms (vomiting or diarrhoea) or respiratory symptoms (sore throat, common cold).

These more specific symptoms and signs may become more obvious as time passes:

• severe headache
• bright light will be uncomfortable (photophobia)
• neck stiffness (nuchal rigidity)
• confusion
• drowsiness
• a third of people with bacterial meningitis may have one or more fits.

If meningitis is moderate to severe, the neck cannot be bent forward fully so that the chin touches the chest.

Photophobia and neck stiffness may not occur in very young or old people or those with a weakened immune system.

The following are important signs in babies and young children:

• a high pitched cry
• breathing problems
• cuddling increases their irritability rather than soothes
• the fontanelles become tense or swollen due to increased pressure inside the head
• the neck and back may arch or bend backwards.

It is not possible to reliably tell the difference between viral meningitis and bacterial meningitis by a doctor’s examination alone, although viral meningitis is usually less severe. However, 55 to 70 per cent of people with meningococcal meningitis have a typical rash, which:

• appears as small red/purple spots between one and two millimetres in diameter or as large purple/black bruises.
• is usually found on or around the armpits, groin, ankles and underwear and sock lines.
• does not blanche, or go pale, when pressed upon.

A simple test is to press a glass against the rash. If the red/purple spots do not disappear then a diagnosis of meningococcal meningitis is likely.

If the doctor finds:

• a reduced level of consciousness or coma
• swelling of the nerve at the back of the eye (papilloedema) - seen using an
ophthalmoscope)
Increased pressure in the head is the likely cause.

If there are:

• focal signs (e.g. weakness or numbness down one side)
• speech problems (e.g. getting words jumbled up)
this shows possible damage to the brain itself and strongly suggests that there
is a brain abscess or that a stroke has occurred. Under these circumstances a brain scan should always be done before the spinal fluid is examined. If lumbar puncture is done to extract spinal fluid in someone with a brain abscess, their condition may very rapidly get worse.

Encephalitis

The early signs of encephalitis are:

• headache
• fever
• a general feeling of being unwell

These symptoms develop over hours or a day or two. The initial symptoms may simply suggest ’flu or a similar viral infection. The headache becomes severe and can be linked with:

• vomiting
• altered awareness (e.g. drowsiness or confusion)
• changes in memory or personality
• epileptic fits
• mild to moderate neck stiffness.

1. Herpes simplex encephalitis (HSE)

Herpes simplex encephalitis is the main cause of serious encephalitis in adults. Although this virus is the cause of common cold sores, there is no established link with the appearance of cold sores on the face and the development of encephalitis in the brain.

HSE affects the temporal lobes of the brain. This is the area that controls memory and speech. There may also be weakness down one side of the body. Some patients may go into a coma or suffer increased pressure inside the skull as a result of severe infection and fits.

2. Encephalitis linked with childhood viruses

Most of these viruses affect everyone at some time in their life, and yet encephalitis is rare. The reasons for this are not completely understood. Encephalitis linked to childhood viral illnesses is usually mild and may show as:

• increasing unsteadiness while walking
• clumsiness when using the hands,in addition to headache, fever and a general feeling of being unwell.

The following signs may help in making a diagnosis:

• a rash caused by the virus which shows a typical spread and pattern
• swollen parotid salivary glands (mumps)
• widespread increase in the size of the lymph glands in neck and groin
(glandular fever).