Viral meningitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Viral meningitis patients appear lethargic and may be not well oriented. They also appears feverish grading from 38-40 degrees. The signs may differ according to the patient age and the virus causing the disease as well. Different signs can be noticed like photophobia, phonophobia, nuchal rigidity,altered mental status, and skin rash.^[1][2]

Appearance of the patient

• Patients usually appears lethargic and not well oriented.
• Convulsions may also be noticed.

Vital signs

• High to low grade fever (40°C/104°F)
• Hypothermia
• Tachypnea or apnea

Skin

• Vesicular or macular skin rash
• Petichiae

HEENT

• Headache
• Photophobia
• Phonophopia
• Pharyngitis in case of enterovirus infeciton
• Orchitis in case of mumps infection

Neck

• Nuchal rigidity
• Signs of meningeal irritation:
  • Kernig’s sign
  • Brudzinski’s sign

Lungs

• Lungs are normal in cases of the viral meningitis

Heart

• Normal heart sounds
• No murmurs, gallops or rubs

Abdomen

• Gastroenteritis especially in cases if enteroviral meningitis

Neuromuscular

• Altered mental status
• Hypotonia
• Normal deep tendon reflexes

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