The child for whom no lumbar puncture was performed had neurologic deterioration, meningism
, and bilateral papilloedema; this child was treated empirically.
She had significant meningism
and bilateral enlarged, non-tender cervical lymph nodes in the anterior and posterior triangles, but no focal neurological deficit at this point.
For 3 of these persons (2 men, 44 and 65 years of age; and 1 woman, 60 years of age), similar to the index patient, a typical biphasic course and symptoms of TBE (nonspecific flu-like symptoms followed by fever, cephalea, meningism
, and ataxia after 4-10 days) developed and they were hospitalized.
In addition to measuring the head circumference, clues in the neurological examination that indicate a secondary cause would include depressed or altered level of consciousness, meningism
, papilloedema (useful in older children to confirm raised intracranial pressure) and focal signs, including cranial nerve palsies and hemiparesis.
Acute CNS infections were suspected in those children with a febrile illness (<2 weeks' duration) and 1 of the following signs or symptoms: meningism
, photophobia, severe headache, altered mental status, seizures, or focal neurologic signs.
In HIV-infected patients, fever (86%), headache (93%), and meningism
(50%) occurred in most patients; by contrast, patients with neuro-surgical devices bad lower rates of meningism
(18%) and headaches (18%) but comparable rates of fever (82%) (10).
fever, headache, muscle pain, meningism
, conjunctival suffusion, and jaundice), together with hemoptysis, hepatomegaly, diarrhea, hypotension, and reduced urine output.
6) (n = 36) Glasgow Coma Score ([double dagger]) 15 (15) (n = 38) Meningism
(%) 2 (5) (n = 39) Hematocrit (%) ([double dagger]) 40 (13-48) (n = 35) Leukocyte count (x [10.
Somnolence, slurred speech, amnestic dysphasia, and impaired fine motor control, but no meningism
, focal signs, pyramidal tract, or sensation impairment, were observed.