Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • headache
  • nausea and vomiting
  • photophobia
  • neck stiffness
  • fever

Other diagnostic factors

  • rash
  • Kernig sign
  • Brudzinski sign

Risk factors

  • infants and young children
  • young adults
  • older people
  • summer and autumn
  • exposure to mosquito or tick vector
  • unvaccinated for mumps
  • use of swimming pools and ponds
  • immunosuppression
  • exposure to rodents

Diagnostic investigations

1st investigations to order

  • CSF microscopy
  • CSF Gram stain
  • CSF bacterial culture
  • CSF protein
  • CSF glucose
  • CT/MRI head
Full details

Investigations to consider

  • EEG
  • CSF viral culture
  • PCR for enteroviruses
  • PCR for herpes viruses
  • HIV serology/HIV reverse transcriptase (RT)-PCR
Full details

Emerging tests

  • CSF C-reactive protein (CRP)
  • serum and CSF procalcitonin
  • CSF lactate
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

John Williams

Consultant

The James Cook University Hospital

Middlesbrough

UK

Disclosures

JW declares that he has no competing interests.

Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this monograph. DC is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

John and Nancy Nelson Professor of Neurology

Indiana University School of Medicine

Indianapolis

IN

Disclosures

KR declares that she has no competing interests.

Professor of Pediatrics

University of Athens

Aghia Sophia Children's Hospital

Athens

Greece

Disclosures

VS declares that she has no competing interests.

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