Inflammation of the meninges
Classic triad:Fever,Headache (Severe, frontal), photophobia, n/v Jolt accentuation
Meningismus/altered mental status

Meningeal signs
Kernig sign: one leg with hip flexed, pain in back with extension of knee
Brudzinski sign: flexion of legs and thighs when neck is flexed

Inflammation of the cerebral cortex
Fever, HA, altered mental status
Key: early mental status changes
More commonly viruses
Behavioral or speech problems, neurological signs, seizures
Difference from meningitis: less likely fever, more likely personality/behavioral changes

Meningitis in the Elderly
Decreased total  incidence; increased in elderly
Increased prevalence of Listeria (25%)
30-50%:  S. pneumoniae
Less likely Neisseria and Haemophilus
Less likely fever and meningeal signs; more likely neurological symptoms, seizure, coma
More often complicated by pneumonia
Older patients with neurological impairment:  50% mortality

The Lumbar Puncture: Risks
Headache: 10-25%
Typical: appears suddenly upon standing
Decrease CSF pressure with small leak
Decrease risk: small (<20 g) needle, leave patient prone after procedure
Infection (small)
Local bleeding: traumatic tap to epidural hematoma
Brain herniation.....

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