- Patients suspected of having meningitis require an LP and early antibiotic therapy. No single item on history or physical exam is accurate enough to rule in or out meningitis:
- Signs of meningeal irritation such as Brudzinski or Kernig's are rarely seen in patients with meningitis (low sensitivity). Nuchal rigidity is commonly seen in elderly patients without meningitis (low specificity)
- Although there is limited data, the jolt accentuation maneuver may be the most helpful sign in meningitis
- Four days of dexamethasone started before or with the first dose of antibiotics has been shown to decrease mortality. The subgroups that benefited most in this RCT were patients with strep pneumonaie meningitis or severe disease (GCS < 11)
- Check out the official IDSA guidelines to review the complete management of meningitis
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