History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include age (most commonly seen in infants and young children, but also young adults and older people) and exposure to insect vectors.

headache

The most common presenting feature.[2][35] In a large multicentre cohort study in the UK, 99% of patients with viral meningitis had a headache on admission to hospital.[6]

photophobia

In a large multicentre cohort study in the UK, 80% of patients with viral meningitis had photophobia on admission to hospital.[6]

neck stiffness

For all meningitis, sensitivity is 44% and specificity 80% in children.[61]

Present in more than 60% of cases of enteroviral meningitis in adults.​[6]​

fever

In a large multicentre cohort study in the UK, 19% of patients with viral meningitis had a fever on admission to hospital.[6]

For all meningitis, sensitivity is 85%.[62]

nausea and vomiting

Common presenting symptom in children.[5] Sometimes seen in adults.[2]

Other diagnostic factors

common

rash

Commonly described in viral meningitis but sensitivity and specificity not identified. Type of rash may indicate the infecting agent (e.g., herpangina is seen with Coxsackie virus A, and a maculopapular rash with echovirus-9). Genital herpes suggests herpes simplex virus type 2 (HSV-2) as the causal agent.

uncommon

Kernig's sign

For all meningitis, sensitivity is 15% and specificity 96% in children.[63]

Sensitivity of 9% and specificity 100% described in adults for all meningitis.[64]

Specificity for all meningitis is 88% in older people.[65]

Uncommon in viral meningitis.

Brudzinski's sign

For all meningitis, sensitivity is 68% and specificity 65% in children.[63]

Uncommon in viral meningitis.

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