Some great stuff as usual from Taming the SRU from the University of Cincinnati Emergency Medicine program about the diagnosis of meningitis. Especially pertinent during enterovirus season:

  • In one study, 95% of people with meningitis had 2/3 of fever, headache and meningismus – But only 44% had all 3
  • CT prior to LP? The American College of Radiology says do it for papilledema, altered mental status, focal neuro deficit, immunocompromised stated, history of CNS disease.
  • The diagnosis and distinction of viral and bacterial meningitis via CSF studies is not always clear and there can be a lot of overlap, with a significant number of cases of bacterial meningitis with the following specific, yet not sensitive findings:
    • WBC2,000
    • Glucose<34
    • Blood:csf ratio<0.23
    • protein >220mg/dL