Meningitis | Cases

CASE HISTORY

14 year old girl admitted to hospital with 24 hour history of fever, increasing headache associated with 6 episodes of vomiting in evening. She has developed photophobia. Also feels generally unwell with myalgia.

GP visited and gave IM penicillin as meningitis considered the most likely diagnosis. GP arranged transfer to hospital by 999 ambulance

QUESTIONS ON CASE 6

Q 1 of 10: What Dx does history suggest?
(Choose one)

Bacterial meningitis <incorrect

Viral meningitisEither viral or bacterial, not enough information to differentiate

INCORRECT : Although multiple episodes of vomiting are suggestive of bacterial meningitis, GP has to proceed on a clinical diagnosis based on signs and symptoms since no pre-hospital method is available to confirm the cause. Pre-hospital management is the same if meningitis is in the differential diagnosis.

Further Information

Symptoms of meningitis

The main symptoms of meningitis are all due to the dysfunction of the central nervous system. Be aware that symptoms can vary according to the age of the child. Symptoms include:

Fever
Headache
Vomiting
Drowsiness/confusion
Fits
Photophobia (less common in young children)
Neck stiffness (less common in young children)
Signs of raised intracranial pressure – complications of meningitis

Young children may have fever and vomiting associated with irritability, drowsiness and confusion. They may be very hard to assess and parent’s anxieties about their state of responsiveness and alertness must always be taken seriously. ²²

Older children are more likely to have fever, vomiting and complain of headache, stiff neck and photophobia. ⁷

Teenagers may present with symptoms related to a change in behaviour such as confusion or aggression. These may mimic the symptoms of alcohol or drug intoxication 23.

CASE HISTORY

QUESTIONS ON CASE 6

Symptoms of meningitis

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