Meningitis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍feverheadachestiff neck

Symptoms include:

‍fever, up to ‍°, over ‍ ‍hoursdays

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍stiff neck

‍sensitivity to light

‍confusion

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍seizures

‍rash

‍sleepiness

‍loss of appetite

‍irritability



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍recent viral infection

‍recent bacterial infection

‍recent head injury

‍exposure to individuals with meningitis

no history of: ‍meningitis, ‍immunodeficiency disorders, ‍ear or sinus infection

no use of: ‍immunosuppressants, ‍corticosteroids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Meningitis ‍likelysuspectedpossible

DDx: bacterial meningitis, viral meningitis, encephalitis, HSV encephalitis, brain abscess, subdural empyema, epidural abscess, viral infection, flu, acute sinusitis, migraine cerebral malaria, systemic infection with secondary CNS involvement, sarcoidosis, autoimmune diseases (e.g., lupus, Sjögren's syndrome), subarachnoid hemorrhage





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍coagulation panel, ‍blood gas ‍blood cultures

- CT scan of the head

- Lumbar puncture

- Nasopharyngeal swab for viral PCR

- Chest X-ray

- Urinalysis and culture

Treatments:

- IV fluids

- ‍Antibiotics

- ‍Antivirals

- ‍Corticosteroids

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Antiemetics

Further care:

- Admission to intensive care unit

- Referral to infectious disease specialist

- Referral to neurologist