M Tuberculoma, presenting with features of meningism
like neck rigidity, positive Kernig's sign and Brudzinski's sign is not very common, but it was the presenting feature in our patient.
Patients with fever, meningism
, confusion, focal signs and a history suggestive of vascular lesions or risk factors for dural venous sinus thrombosis should have a CECT only.
* Neck stiffness as cerebellar tonsils compress against the foramen magnum (as opposed to meningism
from meningitis beware of performing a lumbar puncture in the patient with tonsillar herniation)
For this reason it should be considered in the differential diagnosis even in the absence of associated clinical symptoms more suggestive of meningeal carcinomatosis such as headache (58%), altered consciousness (24%), meningism
(19%), focal signs (34%), dizziness (15%), seizures (10%), and cranial nerves other than ocular involvement (32%).
Meningococcal disease is typically diagnosed in children at presentation to a hospital after the onset of late-occurring classic symptoms, including hemorrhagic rash, meningism
, and impaired consciousness.
Presenting symptoms included retroauricular edema and/or erythema in 41 cases (77.4%), auricular proptosis in 37 cases (69.8%), otalgia in 16 cases (30.2%), headache in 11 cases (20.8%), otorrhea in 11 cases, vomiting in 5 cases (9.4%), meningism
in 5 cases, vertigo in 4 cases (7.5%), facial nerve paralysis in 3 cases (5.7%), ataxia in 2 cases (3.8%), and impaired vision, aphasia, and hemiparesis in 1 case each (1.9%).
HPS may be mistaken for influenza or aseptic meningitis, except that sore throats, coryza (inflammation of the nasal membranes) and meningism
(irritation of the brain and spinal cord) are not common in HPS patients. In cases studied at the University of New Mexico's Medical Center, patients with HPS could be distinguished from those with septicemic shock by the high systemic vascular resistance and decreased cardiac index.
Grades (Gd) refer to Hunt and Hess grades at the time of treatment, grade I being asymptomatic or minimal meningism
, grade II moderate or severe meningism
but no neurological deficit excepting cranial nerve palsies, and grade III drowsy, confused, or a mild focal deficit.
The clinical characteristics collected at admission were fever (temperature >38[degrees]C); myalgia; low back pain; visual disorders (myopic shift, blurred vision); chest symptoms (cough, dyspnea, chest auscultation abnormalities, pathologic chest radiograph); digestive symptoms (nausea, diarrhea, abdominal pain); oliguria (urine output <500 mL/d); neurologic signs (meningism
, headache without meningism
); and nonsevere hemorrhagic signs (hematuria, mucosal bleeding, purpura, petechiae, conjunctival hemorrhage).
Blood cultures are obtained from neonates and children presenting with clinical signs and/or risk factors for severe bacterial infection (including fever, lethargy, shock, meningism
, pneumonia, HIV infection and severe acute malnutrition) or following clinical deterioration during hospitalisation with suspected healthcare-associated infection (HAI).
The other brainstem reflexes were all intact and there was no meningism
. Tonicity in the peripheral limbs was normal, and muscle power was grossly intact globally but difficult to assess.
On admission she was febrile and confused with right ptosis, mydriasis, left hemiparesis, and meningism
. Visual acuity was not recorded and endocrinology profile was not done.