Meningeal Irritation : A Review

Abstract

Cases of meningeal irritation are prevalent worldwide and much Infectious and non-infectious
aetiology exist for this condition. Sub-arachnoid haemorrhage (SAH), central nervous system
sarcoidosis(neuro-sarcoidosis) . systemic lupus erythematosus (SLE), drugs and chemicals are
the non-infectious causes of meningeal irritation. But much is focused on infectious causes
because infection of the central nervous system (CMS) is a medical emergency. The clinical
constellation of fever, headache and neck-stiffness is diagnostic of meningitis. Other clinical
findings like Kernig's sign, Brudzinski's sign and extensor plantar responses support the
diagnosis of meningitis and / or meningo-encephalitis. The clinical onset of sudden severe
headache, vomiting and unconsciousness is diagnostic of SAH. Neck rigidity, positive Kernig's
sign and sub-hyaloid haemorrhage on fundoscopic examination support the diagnosis.
However, diagnosis of meningitis and its treatment is very much important and critical in
particular. A patient presenting with fever and unconsciousness with no substantial pre-existing
illness eg. HTN, DM, endocrinopathy and.' or history of traveling from a malarial epidemic area
should be differentially considered meningo-encephalitis for once at least.

doi: 10.3329/taj.v15i2.3922

TAJ December 2002; Vol.15(2): 108-114