Meningitis and encephalitis
Description
- Meningitis = inflammation of the meninges -> fever + headache + neck stiffness + photophobia
- Encephalitis = inflammation of brain parenchyma -> *altered mental state, personality/behaviour change, seizures, focal neurological deficits*
- Meningoencephalitis = both; the clinical distinction is one of emphasis, and management must cover both until the cause is known
The discriminator
| Meningitis | Encephalitis | |
|---|---|---|
| Dominant feature | Meningism | Altered cerebral function |
| Conscious level | Usually preserved | Impaired |
| Focal signs / seizures | Uncommon | Common |
| Commonest serious cause | S. pneumoniae, N. meningitidis | HSV-1 |
- *The classic triad (fever + neck stiffness + altered mental state) is present in fewer than half of adults with bacterial meningitis - but >95% have at least two of fever, headache, neck stiffness or altered mental state*
- Elderly and immunocompromised patients may present only with confusion or collapse, without fever or meningism
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