Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck
Always consider in the context of headache & fever.
There may be vomiting, photophobia, neck pain/ stiffness, confusion, coma, irritability or fitting.
Look for neck stiffness & Kernig’s signs, purpura, hypotension.
Look for source of infection (contacts, otitis media, sinusitis) other viral illnesses.
Usual causes: viral, Strep. pneumonia,Haemophilus Influenzae, Neiss. Meningiditis. Crytococcus common in immunosuppressed & in HIV.
1. ABC’s & resuscitation as indicated
2. Inform maedical expediently
3. Treat immediately as bacterial mengitis if diagnosis likely
4. IV access
5. FBC, U&E’s, LFT’s, CRP, Blood Culture
6. Nose, Throat & Ear swabs
7. Consider viral cultures & antibody titres,
8. LumbarPuncture – all need an LP, usually after a CT has shown no other causes for their presenting symptoms. CT usually unnecessary if: adult <60 years, not immunocompromised,no history of CNS disease, no seizures, normal level of consciousness & no focal neurology
9. IV antibiotics:
· Give early (even before LP) if unwell or delay to LP likely,
· Ceftriaxone 50 mg/kg up to 2 g IV BD if unknown source of H.influenzae suspected
· Benzlypenicillin 60 mg/kg up to 1.8 g IV 4-hourly if Pneumonococcus or Meningococcus likely,
· Amphoteracin B 0.7 mg/kg IV for Cryptococcus.
10. Consider swabbing & treating close contacts
11. Inappropriate antibiotic can be ceased once organism & susceptibility are known
12. Consider steroid treatment: Strong support for use of IV Dexamethazone in infants & children, early use in adults acute bacterial meningitis (esp pneumococcal) probably beneficial.
Pressure 70-180 mm.
· Don’t remove CSF if pressure >350 mm,
· Increases in meningitis, tumors, absesses, haemorrhage & benign intracranial hypertension,
· Reduced in dehydration, diabetic coma & hyperventilation.